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Novelty in the gut: a systematic review and meta-analysis of the gastrointestinal manifestations of COVID-19
  1. Vishnu Charan Suresh Kumar1,
  2. Samiran Mukherjee1,
  3. Prateek Suresh Harne1,
  4. Abinash Subedi1,
  5. Muthu Kuzhali Ganapathy2,
  6. Venkata Suresh Patthipati3,
  7. Bishnu Sapkota4,5
  1. 1 Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
  2. 2 Department of General Medicine, Sri Ramaswamy Memorial Group of Educational Institutions, Chennai, Tamil Nadu, India
  3. 3 Department of Internal Medicine, Trumbull Regional Medical Center, Warren, Ohio, USA
  4. 4 Division of Gastroenterology, Syracuse VA Medical Center, Syracuse, New York, USA
  5. 5 Division of Gastroenterology, SUNY Upstate Medical University, Syracuse, New York, USA
  1. Correspondence to Dr Vishnu Charan Suresh Kumar; drvishnucharan{at}


Background The COVID-19 epidemic has affected over 2.6 million people across 210 countries. Recent studies have shown that patients with COVID-19 experience relevant gastrointestinal (GI) symptoms. We aimed to perform a systematic review and meta-analysis on the GI symptoms of COVID-19.

Methods A literature search was conducted via electronic databases, including PubMed, Embase, Scopus, and Google Scholar, from inception until 20 March 2020. Data were extracted from relevant studies. A systematic review of GI symptoms and a meta-analysis comparing symptoms in severe and non-severe patients was performed using RevMan V.5.3.

Results Pooled data from 2477 patients with a reverse transcription-PCR-positive COVID-19 infection across 17 studies were analysed. Our study revealed that diarrhoea (7.8%) followed by nausea and/or vomiting (5.5 %) were the most common GI symptoms. We performed a meta-analysis comparing the odds of having GI symptoms in severe versus non-severe COVID-19-positive patients. 4 studies for nausea and/or vomiting, 5 studies for diarrhoea and 3 studies for abdominal pain were used for the analyses. There was no significant difference in the incidence of diarrhoea (OR=1.32, 95% CI 0.8 to 2.18, Z=1.07, p=0.28, I2=17%) or nausea and/or vomiting (OR=0.96, 95% CI 0.42 to 2.19, Z=0.10, p=0.92, I2=55%) between either group. However, there was seven times higher odds of having abdominal pain in patients with severe illness when compared with non-severe patients (OR=7.17, 95% CI 1.95 to 26.34, Z=2.97, p=0.003, I2=0%).

Conclusion Our study has reiterated that GI symptoms are an important clinical feature of COVID-19. Patients with severe disease are more likely to have abdominal pain as compared with patients with non-severe disease.

  • diarrhoea
  • gastrointestinal pathology
  • infectious diarrhoea
  • epidemiology
  • abdominal pain

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  • Contributors VCSK (Conceptualisation: lead; Data curation: equal; Formal analysis: supporting; Methodology: lead; Supervision: equal; Writing–original draft: equal; Writing–review and editing: equal). VCSK is responsible for the overall content of this manuscript. SM (Data curation: equal; Formal analysis: equal; Methodology: equal; Writing–original draft: equal; Writing–review and editing: equal). PH (Data curation: equal; Writing–original draft: equal; Writing–review and editing: equal). AS (Data curation: equal). MKG (Data curation: supporting; Formal analysis: equal; Methodology: supporting). VSP (Formal analysis: lead; Validation: lead; Writing–original draft: supporting). BS (Methodology: supporting; Supervision: lead; Writing–review and editing: equal).

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All relevant data are included in the study.

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