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Prevalence of Gastrointestinal Symptoms and Fecal Viral Shedding in Patients With Coronavirus Disease 2019: A Systematic Review and Meta-analysis.
JAMA Netw Open. 2020 06 01; 3(6):e2011335.JN

Abstract

Importance

Coronavirus disease 2019 (COVID-19) is a global pandemic and can involve the gastrointestinal (GI) tract, including symptoms like diarrhea and shedding of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in feces.

Objective

To provide a pooled estimate of GI symptoms, liver enzyme levels outside reference ranges, and fecal tests positive for SARS-CoV-2 among patients with COVID-19.

Data Sources

An electronic literature search was performed for published (using MEDLINE/PubMed and Embase) and preprint (using bioRxiv and medRxiv) studies of interest conducted from November 1, 2019, to March 30, 2020. Search terms included "COVID-19," "SARS-Cov-2," and/or "novel coronavirus."

Study Selection

Eligible studies were those including patients with SARS-CoV-2 infection who reported GI symptoms.

Data Extraction and Synthesis

Data on patients with GI symptoms (ie, diarrhea, nausea, or vomiting), liver enzyme level changes, and fecal shedding of virus were extracted. Quality of studies was examined using methodological index for nonrandomized studies. Pooled estimates (%) were reported with 95% CIs with level of heterogeneity (I2).

Main Outcomes and Measures

Study and patient characteristics with pooled detection rates for diarrhea, nausea or vomiting, liver enzyme levels outside reference ranges, and SARS-CoV-2 positivity in feces tests were analyzed.

Results

Of 1484 records reviewed, 23 published and 6 preprint studies were included in the analysis, with a total of 4805 patients (mean [SD] age, 52.2 [14.8] years; 1598 [33.2%] women) with COVID-19. The pooled rates were 7.4% (95% CI, 4.3%-12.2%) of patients reporting diarrhea and 4.6% (95% CI, 2.6%-8.0%) of patients reporting nausea or vomiting. The pooled rate for aspartate aminotransferase levels outside reference ranges was 20% (95% CI, 15.3%-25.6%) of patients, and the pooled rate for alanine aminotransferase levels outside reference ranges was 14.6% (95% CI, 12.8%-16.6%) of patients. Fecal tests that were positive for SARS-CoV-2 were reported in 8 studies, and viral RNA shedding was detected in feces in 40.5% (95% CI, 27.4%-55.1%) of patients. There was high level of heterogeneity (I2 = 94%), but no statistically significant publication bias noted.

Conclusions and Relevance

These findings suggest that that 12% of patients with COVID-19 will manifest GI symptoms; however, SAR-CoV-2 shedding was observed in 40.5% of patients with confirmed SARS-CoV-2 infection. This highlights the need to better understand what measures are needed to prevent further spread of this highly contagious pathogen.

Authors+Show Affiliations

Swedish Medical Center, Seattle, Washington.Kansas City Veterans Affairs Medical Center, Kansas City, Missouri.University of Kansas Medical Center, Kansas City.Ochsner Clinic Foundation, New Orleans, Louisiana.St Luke's Medical Center, Kansas City, Missouri.Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany.Instituto Clinico Humanitas, Department of Endoscopy, Humanitas University School of Medicine, Milano, Italy.Instituto Clinico Humanitas, Department of Endoscopy, Humanitas University School of Medicine, Milano, Italy.Instituto Clinico Humanitas, Department of Endoscopy, Humanitas University School of Medicine, Milano, Italy.Division of Gastrointestinal Endoscopy, University of São Paulo School of Medicine, São Paulo, Brazil.Instituto Clinico Humanitas, Department of Endoscopy, Humanitas University School of Medicine, Milano, Italy.Kansas City Veterans Affairs Medical Center, Kansas City, Missouri.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

32525549

Citation

Parasa, Sravanthi, et al. "Prevalence of Gastrointestinal Symptoms and Fecal Viral Shedding in Patients With Coronavirus Disease 2019: a Systematic Review and Meta-analysis." JAMA Network Open, vol. 3, no. 6, 2020, pp. e2011335.
Parasa S, Desai M, Thoguluva Chandrasekar V, et al. Prevalence of Gastrointestinal Symptoms and Fecal Viral Shedding in Patients With Coronavirus Disease 2019: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(6):e2011335.
Parasa, S., Desai, M., Thoguluva Chandrasekar, V., Patel, H. K., Kennedy, K. F., Roesch, T., Spadaccini, M., Colombo, M., Gabbiadini, R., Artifon, E. L. A., Repici, A., & Sharma, P. (2020). Prevalence of Gastrointestinal Symptoms and Fecal Viral Shedding in Patients With Coronavirus Disease 2019: A Systematic Review and Meta-analysis. JAMA Network Open, 3(6), e2011335. https://doi.org/10.1001/jamanetworkopen.2020.11335
Parasa S, et al. Prevalence of Gastrointestinal Symptoms and Fecal Viral Shedding in Patients With Coronavirus Disease 2019: a Systematic Review and Meta-analysis. JAMA Netw Open. 2020 06 1;3(6):e2011335. PubMed PMID: 32525549.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence of Gastrointestinal Symptoms and Fecal Viral Shedding in Patients With Coronavirus Disease 2019: A Systematic Review and Meta-analysis. AU - Parasa,Sravanthi, AU - Desai,Madhav, AU - Thoguluva Chandrasekar,Viveksandeep, AU - Patel,Harsh K, AU - Kennedy,Kevin F, AU - Roesch,Thomas, AU - Spadaccini,Marco, AU - Colombo,Matteo, AU - Gabbiadini,Roberto, AU - Artifon,Everson L A, AU - Repici,Alessandro, AU - Sharma,Prateek, Y1 - 2020/06/01/ PY - 2020/6/12/entrez PY - 2020/6/12/pubmed PY - 2020/7/1/medline SP - e2011335 EP - e2011335 JF - JAMA network open JO - JAMA Netw Open VL - 3 IS - 6 N2 - Importance: Coronavirus disease 2019 (COVID-19) is a global pandemic and can involve the gastrointestinal (GI) tract, including symptoms like diarrhea and shedding of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in feces. Objective: To provide a pooled estimate of GI symptoms, liver enzyme levels outside reference ranges, and fecal tests positive for SARS-CoV-2 among patients with COVID-19. Data Sources: An electronic literature search was performed for published (using MEDLINE/PubMed and Embase) and preprint (using bioRxiv and medRxiv) studies of interest conducted from November 1, 2019, to March 30, 2020. Search terms included "COVID-19," "SARS-Cov-2," and/or "novel coronavirus." Study Selection: Eligible studies were those including patients with SARS-CoV-2 infection who reported GI symptoms. Data Extraction and Synthesis: Data on patients with GI symptoms (ie, diarrhea, nausea, or vomiting), liver enzyme level changes, and fecal shedding of virus were extracted. Quality of studies was examined using methodological index for nonrandomized studies. Pooled estimates (%) were reported with 95% CIs with level of heterogeneity (I2). Main Outcomes and Measures: Study and patient characteristics with pooled detection rates for diarrhea, nausea or vomiting, liver enzyme levels outside reference ranges, and SARS-CoV-2 positivity in feces tests were analyzed. Results: Of 1484 records reviewed, 23 published and 6 preprint studies were included in the analysis, with a total of 4805 patients (mean [SD] age, 52.2 [14.8] years; 1598 [33.2%] women) with COVID-19. The pooled rates were 7.4% (95% CI, 4.3%-12.2%) of patients reporting diarrhea and 4.6% (95% CI, 2.6%-8.0%) of patients reporting nausea or vomiting. The pooled rate for aspartate aminotransferase levels outside reference ranges was 20% (95% CI, 15.3%-25.6%) of patients, and the pooled rate for alanine aminotransferase levels outside reference ranges was 14.6% (95% CI, 12.8%-16.6%) of patients. Fecal tests that were positive for SARS-CoV-2 were reported in 8 studies, and viral RNA shedding was detected in feces in 40.5% (95% CI, 27.4%-55.1%) of patients. There was high level of heterogeneity (I2 = 94%), but no statistically significant publication bias noted. Conclusions and Relevance: These findings suggest that that 12% of patients with COVID-19 will manifest GI symptoms; however, SAR-CoV-2 shedding was observed in 40.5% of patients with confirmed SARS-CoV-2 infection. This highlights the need to better understand what measures are needed to prevent further spread of this highly contagious pathogen. SN - 2574-3805 UR - https://www.unboundmedicine.com/medline/citation/32525549/Prevalence_of_Gastrointestinal_Symptoms_and_Fecal_Viral_Shedding_in_Patients_With_Coronavirus_Disease_2019:_A_Systematic_Review_and_Meta_analysis_ L2 - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2020.11335 DB - PRIME DP - Unbound Medicine ER -