Prevalence of GI and Liver Manifestations of COVID-19 Infection

Background and Objective: Gastrointestinal (GI) symptoms and lab abnormalities are described in patients with COVID-19 infection. To estimate the prevalence of these manifestations in patients with COVID-19, the AGA conducted a systematic review of published and unpublished studies, performed a meta-analysis, and provides clinical practice recommendations.

Key Findings

The meta-analysis included 47 studies with data from 10,890 patients with COVID-19. Not all symptoms were reported in each study. Pooled prevalence rates of GI symptoms and liver chemistry abnormalities were as follows:

• Abdominal pain: 3.6%

• Diarrhea: 7.7%

• Nausea/vomiting: 7.8%

• Elevated serum aspartate aminotransferase (AST) level: 15%

• Elevated serum alanine aminotransferase (ALT) level: 15%

• Elevated serum total bilirubin level: 16.7%

Key Recommendations

• Among outpatients with new-onset diarrhea, evaluate contact exposures. and obtain detailed histories of symptoms associated with COVID-19 and other GI symptoms (nausea, vomiting, abdominal pain).

• Among outpatients with new-onset GI symptoms, monitor for other COVID-19 symptoms and consider COVID-19 testing, as GI symptoms may precede pulmonary symptoms.

• Among hospitalized patients with known or suspected COVID-19, obtain a history of GI symptoms.

• Do not perform stool testing for COVID-19.

• Look for other etiologies of liver injury when serum liver chemistries are elevated in patients with known or suspected COVID-19.

• Obtain baseline and subsequent serum liver chemistries in hospitalized patients with known or suspected COVID-19 infection.

• Recognize that treatments for COVID-19 infection may produce GI symptoms and/or serum liver chemistry abnormalities and evaluate for these.