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{"project":"LitCovid-PD-GO-BP","denotations":[{"id":"T40","span":{"begin":1833,"end":1857},"obj":"http://purl.obolibrary.org/obo/GO_1903902"},{"id":"T41","span":{"begin":1840,"end":1857},"obj":"http://purl.obolibrary.org/obo/GO_0019079"},{"id":"T42","span":{"begin":1840,"end":1857},"obj":"http://purl.obolibrary.org/obo/GO_0019058"},{"id":"T43","span":{"begin":2559,"end":2576},"obj":"http://purl.obolibrary.org/obo/GO_0019079"},{"id":"T44","span":{"begin":2559,"end":2576},"obj":"http://purl.obolibrary.org/obo/GO_0019058"},{"id":"T45","span":{"begin":2687,"end":2696},"obj":"http://purl.obolibrary.org/obo/GO_0046903"},{"id":"T46","span":{"begin":4277,"end":4294},"obj":"http://purl.obolibrary.org/obo/GO_0019079"},{"id":"T47","span":{"begin":4277,"end":4294},"obj":"http://purl.obolibrary.org/obo/GO_0019058"},{"id":"T48","span":{"begin":6158,"end":6172},"obj":"http://purl.obolibrary.org/obo/GO_0019076"},{"id":"T49","span":{"begin":6242,"end":6256},"obj":"http://purl.obolibrary.org/obo/GO_0019076"}],"text":"Table 4 Gastrointestinal manifestations of SARS-CoV, MERS-CoV and COVID-19.\nSARS (only studies with large study population included)\nStudy Lee et al (2003)N = 138, suspectedRetrospective study Donnelly et al (2003)N = 1425, confirmed casesRetrospective study Peiris et al (2003)N = 75, confirmed casesProspective study Leung et al (2003)N = 138, confirmed casesRetrospective study Choi et al (2003)N = 267 (227 confirmed cases)Retrospective study Shi et al (2005)N = 14, (7 confirmed cases, 7 suspected)Clinicopathologic study Kwan et al (2005)N = 240, confirmed casesRetrospective Study\nClinical Features • Diarrhea (19.6%)\n• Nausea and vomiting (19.6%) • Loss of appetite (54.6%)\n• Diarrhea (27%)\n• Vomiting (14%)\n• Abdominal pain (13%) Watery diarrhea (73%) (1% on admission)• 7.5 ± 2.3 days of symptom onset\n• frequency 6.3 ± 3.5/day\n• Peak 8.7 ± 2.3 days, improved in all by day 13 Watery diarrhea (38.4 % within first week, 20.3% on presentation)• Average duration: 3.7 ±2.7\n• 5.8% only GI symptoms on presentation • Loss of appetite (23%)\n• Watery diarrhea (15% on admission, increased to 53% after hospitalization, median 3 days after) (frequency 3-20/day)\n• Vomiting (7%) • Diarrhea (1/7)\n• Upper GI hemorrhage (2/7)\n• Hematochezia (1/7) • Watery diarrhea (20.4%)\n• 7.5 ±2.8 days after fever onset\n• (Peak day 12)\n• OR: 3 for patients with diarrhea to have continued diarrhea on follow up\nKey findings on investigations • ↑ baseline albumin• ↓ K+ N/A Viral RNA in stool (97%) (14.4 ± 2.2 days from onset) • ↓ K+• Viral RNA in stool (16%)• No viral isolation from stool• Colonoscopy (1) grossly within normal limits ↓ K+ (41%) N/A K+ nadir lower in diarrheal patients than nondiarrheal (P \u003c 0.05)\nHistopathology N/A N/A N/A • On EM, viral particles detected in epithelial cells of bowel within ER, and in surface microvilli, active viral replication in intestines\n• Able to isolate virus by culture from small intestine N/A • Diarrheal patient: Pseudomembranous plaques, shallow ulcers in TI, scattered hemorrhagic spots in gastric mucosa\n• Patients with bleeding: coffee ground liquid in GIT\n• Lymphoid tissue depletion in all\n• SARS-CoV particles detected in epithelial cells in diarrheal patient only N/A\nKey study findings and message GI symptoms were less common GI symptoms less common at presentation 21%: concomitant fever, diarrhea, and radiological worsening • Patients with GI symptoms had higher ICU admission (P \u003c 0.001, higher requirement of ventilatory support (P = 0.004)\n• GI symptoms may be due to proteins or toxins produced during viral replication • Diarrheal patients had nonstatistically significant higher rates of positive serological and nasopharyngeal secretion testing\n• GI symptoms may be due to direct enteric infection by virus or antibiotic treatment GI symptoms may be due to:• Acute immune damage\n• Via infected lymphocytes\n• Opportunistic infections GI symptoms more common in:• F\u003eM (6:1) (P \u003c 0.001)\n• Geographical (Amoy Gardens Estate residents) (P = 0.01)\n• Patients with GI symptoms had lower mortality and ventilator requirement (P \u003c 0.005)\n• CXR scores at peak of diarrhea did not correlate with frequency\nMERS\nStudy Assiri et al (2013)N = 47, confirmed casesRetrospective study Corman et al (2015)N = 37, confirmed casesClinicopathologic study Alenazi et al (2017)N = 130, confirmed casesClinicopathologic study Zhou et al (2017)Human intestinal epithelial cell culture, hDDP4 transgenic miceClinicopathologic Al-Abdley et al (2019)N = 33, confirmed casesClinicopathologic study\nClinical features • Diarrhea (26%)\n• Nausea (21%)\n• Vomiting (21%)\n• Abdominal pain (17%)\n(at presentation) N/A GI symptoms in• Community acquired infection: 46.2%\n• Healthcare associated infection: 46.6%\n• HAI in healthcare workers: 16% N/A • Vomiting (31%)\n• Diarrhea (15%)\nKey findings on investigations N/A • 14.6% stool yielded viral RNA N/A N/A RNA positive stool (57%) did not correlate with presence of GI symptoms\nKey study findings and message GI symptoms are frequent at presentation • Viral load in stool is significantly lower than in lower respiratory tract\n• Virus not cultivable from stool MERS-CoV high in healthcare environment • GI symptoms among the commonest extrapulmonary symptoms\n• Intestinal epithelial cells could support viral replication\n• Primary gastric infection can lead to respiratory symptoms via hematogenous or lymphatic spread Diarrhea may be associated with prolonged viral detection (p 0.069)\nCOVID-19\nStudy Wang et al (2020)N = 138, confirmed casesClinicopathologic study Guan et al (2020)N = 1099, confirmed casesRetrospective study To et al (2020)N = 12, suspected casesClinicopathologic study Xie et al (2020)N = 19 suspected (9 confirmed cases)Clinicopathologic study Pan et al (2020)N = 204, confirmed casesRetrospective study Wu et al (2020)N = 74, confirmed casesClinicopathologic study\nClinical features • Anorexia (39.9)\n• Diarrhea (10.1)\n• Nausea (10.1%)\n• Vomiting (3.6%)\n• Abdominal pain (2.2%) • Diarrhea (3.8%)\n• Nausea or vomiting (5%) Diarrhea (11.1% of confirmed) • Any GI symptom: 50.5%\n• Only GI symptoms: 0.03%\n• Loss of appetite (39.7% of total, 78.6% of all GI symptoms)\n• Diarrhea (17.1%, 34%, usually 3/day)\n• Vomiting (0.02%, 3.9%)\n• Abdominal pain (0.01%, 1.9%) Diarrhea/Vomit/Stomachache (44.6%)\nKey findings on investigations N/A N/A • 2019-nCoV detected in 91.7% saliva samples\n• Virus cultured from 3/12 saliva samples RNA positive stool samples: 88.9% of confirmed (overall 42%) ↑ALT, AST↑ PT↓monocyte count • RNA positive stool samples: 55%\nKey study findings and message ICU patients more likely to have anorexia and abdominal pain (P \u003c 0.001, P = 0.02) GI symptoms less common • Presence of GI symptoms not associated with stool RNA positivity\n• Fecal transmission possible • Patients with GI symptoms had longer interval from symptom onset to admission (P = 0.013)\n• GI symptoms worsened with severity of disease\n• Patients with GI symptoms more likely to get antibiotics (P = 0.018)\n• No association presence of GI symptoms with total hospital stay, ICU days or mortality • Presence of GI symptoms not associated with stool positivity\n• Prolonged fecal viral shedding up to 5 weeks\n• Disease severity not associated with prolonged fecal viral shedding\n• Fecal transmission possible\nALT, alanine aminotransferase; AST, aspartate aminotransferase; CXR, chest x-ray; EM, electron microscopy; F, female; GIT, gastrointestinal tract; HAI, healthcare associated infection; HAI, healthcare associated infection; MERS-CoV, middle east respiratory syndrome coronavirus; SARS-COV, severe acute respiratory syndrome coronavirus; TI, terminal ileumx."}

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PMC:7212949 / 37686-44329 JSONTXT

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