Gastrointestinal and hepatic manifestations of COVID-19 patients in tertiary care hospitals in Bangladesh
DOI:
https://doi.org/10.18203/2320-6012.ijrms20242915Keywords:
COVID-19, Gastrointestinal symptoms, Hepatic manifestations, Diarrhoea, AnorexiaAbstract
Introduction: The worldwide pandemic of COVID-19 caused by the virus SARS-CoV-2 has continued to progress and increasing information is becoming available about the incidence of gastrointestinal symptoms as well as abnormal liver functions test of the patients who are infected. Patients with severe disease are more likely to developed gastrointestinal symptoms specially diarrhea and altered liver functions test.
Methods: This was a cross-sectional study carried out in COVID-19 inpatients department of BSMMU and DMCH, Dhaka. In total 140 patients, 95 male and 45 female were included in this study.
Result: About 42% patients belonged to mild COVID-19 group, 17% moderate and 41% severe COVID group. In our study 58 (41.4%) patients had diabetes mellitus, 47 (33.6%) had hypertension, 42 (30%) had ischemic heart disease, 11 (7.8%) had bronchial asthma, 8 (5.7%) was obese, 5 (3.5%) had hypothyroidism. Cough was the predominant symptoms in 114 (81%) patients followed by fever 110 (79%), shortness of breath 57 (41%), body ache 51 (36%), sore throat 33 (23%), anosmia 21(15%), others 10 (7%). Among gastrointestinal manifestations anorexia (32.1%) was most common symptoms followed by diarrhoea (29.3%), nausea (16.4%), vomiting (11.4%), abdominal pain (10%) and GI bleeding (2%). GI symptoms were the initial presentation in 18% patients.
Conclusion: This study revealed that gastrointestinal manifestations were present in a significant portion of patients. Diarrhoea was a common GI symptom. Gastrointestinal symptoms were the initial presentation of COVID-19.
References
Gu J, Han B, Wang J. COVID-19: Gastrointestinal manifestations and potential fecal-oral transmission. Gastroenterology. 2020;158:1518-9.
World health organization. Coronavirus disease (COVID-19) pandemic. 2021. Available at: https://www.who.int.
Lin L, Jiang X, Zhang Z, Huang S, Zhang Z, Fang Z, et al. Gastrointestinal symptoms of 95 cases with SARS-CoV-2 infection. Gut. 2020;69:997-1001.
Kariyawasam JC, Jayarajah U, Riza R, Abeysuriya V, Seneviratne SL. Gastrointestinal manifestations in COVID-19. Trans R Soc Trop Med Hyg. 2021;2:12-5.
Elshazli RM, Kline A, Elgaml A, Aboutaleb MH, Salim MM, Omar M, et al. Gastroenterology manifestations and COVID-19 outcomes: A meta-analysis of 25,252 cohorts among the first and second waves. J Med Virol. 2021;93:2740-68.
Remes JM, Ramos DLMA, Manríquez RM, Martínez PML, Lara EL, Solís GMA. Initial gastrointestinal manifestations in patients with severe acute respiratory syndrome coronavirus 2 infection in 112 patients from Veracruz in southeastern Mexico. Gastroenterology. 2020;159:1179-81.
Holshue ML, Debolt C, Lindquist S, Lofy KH, Wiesman J, Bruce H, et al. First Case of 2019 Novel Coronavirus in the United States. N Engl J Med. 2020;382:929-36.
Cheung KS, Hung IFN, Chan PPY, Lung KC, Tso E, Liu R, et al. Gastrointestinal manifestations of Sars-Cov-2 Infection and virus load in faecal samples from a Hong Kong cohort: Systematic review and meta-analysis. Gastroenterology. 2020;159:81-95.
Han C, Duan C, Zhang S, Spiegel B, Shi H, Wang W, et al. Digestive symptoms in COVID-19 patients with mild disease severity: Clinical presentation, stool viral RNA testing, and outcomes. Am J Gastroenterol. 2020;115:916-23.
Khalil MM, Gain G, Mahbub-Uz-Zaman K, Karim ME, Sarker KD, Akter D, et al. Gastrointestinal Manifestations among COVID-19 Patients in Bangladesh: A cross sectional study. Mymensingh Med J. 2020;29:956-63.
Jin X, Lian JS, Hu JH, Gao J, Zheng L. Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut. 2020;69:1002-9.
Zhang C, Shi L, Wang FS. Liver injury in COVID-19: management and challenges. Lancet Gastroenterol Hepatol. 2020;5:428-30.
Ramachandran P, Onukogu I, Ghanta S, Gajendran M, Perisetti A, Goyal H, et al. Gastrointestinal Symptoms and Outcomes in Hospitalized Coronavirus Disease 2019 Patients. Dig Dis. 2020;38:373-9.
Kang MK, Kim KO, Kim MC, Cho JH, Kim SB, Park JG, et al. Clinical characteristics of coronavirus disease 2019 patients with diarrhea in Daegu. Korean J Intern Med. 2020;35:1261-70.
Paul N, Al Azad N, Parveen R, Saha TK, Haque M, Deb SR, et al. Clinical profile of first 100 cases of COVID-19 in a COVID-dedicated hospital of Bangladesh. BIRDEM Med J. 2020;10:18-22.
Bhandari S, Bhargava A, Sharma S, Keshwani P, Sharma R, Banerjee S. Clinical profile of COVID-19 infected patients admitted in a tertiary care hospital in North India. J Assoc Physicians India. 2020;68(5):13-7.
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel Coronavirus pneumonia in Wuhan, China: A Descriptive Study. Lancet. 2020;395:507-13.
Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020;323:2052-9.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497-506.
Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323:1061-9.
European centre for disease prevention and control. novel coronavirus disease 2019 (COVID-19) pandemic: increased transmission in the EU/EEA and the UK – sixth update. Accessed on 20th March 2020.
Akkus C, Yilmaz H, Mizrak S, Adibelli Z, Akdas O, Duran C. Development of pancreatic injuries in the course of COVID-19. Acta Gastroenterol Belg. 2020;83:585-92.
Sattar Y, Connerney M, Rauf H, Saini M, Ullah W, Mamtani S, et al. Three cases of COVID-19 disease with colonic manifestations. Am J Gastroenterol. 2020;115:948-50.
El Moheb M, Naar L, Christensen MA, Kapoen C, Maurer LR, Farhat M, et al. Gastrointestinal complications in critically ill Patients with and without COVID-19. JAMA. 2020;324:1899-901.
Alhassan SM, Iqbal P, Fikrey L, Mohamed Ibrahim MI, Qamar MS, Chaponda M, et al. Post COVID-19 acute acalculous cholecystitis raising the possibility of underlying dysregulated immune response,a case report. Ann Med Surg (Lond). 2020;60:434-7.
Sierra-Arango F, Vergara-Cabra C, Vásquez-Roldan M, Pérez-Riveros ED. Acute surgical‐like abdomen as a gastrointestinal manifestation of COVID-19 infection: a case report in Colombia. BMC Gastroenterol. 2021;21:187.
Marasco G, Maida M, Morreale GC, Licata M, Renzulli M, Cremon C, et al. Gastrointestinal Bleeding in COVID-19 Patients: A systematic review with meta-analysis. Can J Gastroenterol Hepatol. 2021;2021:2534975.
Chan KH, Lim SL, Damati A, Maruboyina SP, Bondili L, Abu Hanoud A, et al. Coronavirus Disease 2019 (Covid-19) and ischemic colitis: An under-recognized complication. Am J Emerg Med. 2020;38:2758.
Trindade AJ, Izard S, Coppa K, Hirsch JS, Lee C, Satapathy SK. Gastrointestinal bleeding in hospitalized COVID-19 patients: a propensity score matched cohort study. J Intern Med. 2021;289:887-94.
