Gastrointestinal and Liver Diseases and COVID-19 (multiple reviews)

Added August 6, 2020

What is this? Some patients with COVID-19 infection will develop gastrointestinal or liver problems and many rapid reviews have been done to investigate this. For more details of these reviews, including citations and links to the full text, scroll down this summary.

What was found: At the time of these reviews, all reported that gastrointestinal symptoms, such as diarrhoea, loss of appetite, nausea, vomiting, and complications such as liver injury may be experienced by people with COVID-19 infection. The presence and severity of gastrointestinal symptoms and complications such as liver injury may be linked to COVID-19 disease severity, and may be useful prognostic indicators. Several reviews reported that liver function tests may be useful prognostic indicators for COVID-19 infection.

At the time of these reviews, the range of patients with COVID-19 infection and evidence of liver dysfunction ranged from 15% (Sultan et al.) to around 50% (Wang et al.), although the cause of these abnormalities was uncertain. Samidoust et al. reported that increasing age increases the risk of liver injury.

Mao et al. reported that some COVID-19 patients may present only with gastrointestinal symptoms; meaning that this patient group may experience delays in diagnosis and tend to have poorer prognosis. But, Sultan et al. reported that isolated gastrointestinal symptoms were rare with COVID-19 infection.

Cheung et al., Parasa et al. and Mao et al. noted that around half of COVID-19 patients in their included studies had detectable viral RNA in stool samples at some stage during COVID-19 infection. Cheung et al. noted that the presence of diarrhoea was associated with higher stool viral levels.

All these rapid reviews supported the theory that COVID-19 may be spread through the faeco-oral route and healthcare workers should take infection prevention precautions when handling stool samples.

What are the reviews:

Citation: Cheung KS, Hung IF, Chan PP, et al. Gastrointestinal manifestations of SARS-CoV-2 infection and virus load in fecal samples from the Hong Kong cohort and systematic review and meta-analysis. Gastroenterology. 2020 Jul 1;159(1):81-95.

In this rapid review, the authors searched for studies assessing COVID-19 infection and gastrointestinal symptoms. They did not restrict their searches by language of publication and did the search on 11 March 2020. They included 69 descriptive and observational studies, and noted marked variation among the included studies.

Citation: Mao R, Qiu Y, He JS, et al. Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis. The Lancet Gastroenterology & Hepatology. 2020 Jul 01;5(7):667-78.

In this rapid review, the authors searched for studies with 10 or more patients of the prevalence of gastrointestinal symptoms and complications in patients with COVID-19 infection. They restricted their searches to articles published in English up to 4 April 2020. They identified 35 studies (total: 6686 patients), mostly from China (32). They assessed all included studies as providing low-quality evidence, with marked variation among them and evidence of publication bias.

Citation: Suresh Kumar VC, Mukherjee S, Harne PS, et al. Novelty in the gut: a systematic review and meta-analysis of the gastrointestinal manifestations of COVID-19. BMJ Open Gastroenterology 2020;7(1):e000417.

In this rapid review, the authors searched for observational studies of gastrointestinal symptoms in adult patients with COVID-19 infection. They restricted their searches to articles published in English and did their most recent search on 4 April 2020. They included 17 studies (2477 patients), mostly from China (15). They assessed the studies as moderate-to-high quality observational evidence and noted the presence of publication bias.

Citation: Wang H, Qiu P, Liu J, et al. The liver injury and gastrointestinal symptoms in patients with Coronavirus Disease 19: a systematic review and meta-analysis. Clinics and Research in Hepatology and Gastroenterology. 2020 May 12.

In this rapid review, the authors searched for studies of with 10 or more patients of liver dysfunction and gastrointestinal symptoms in patients with COVID-19 infection. They restricted their searches to articles published in English did the most recent search was completed on 31 March 2020. They included 21 studies (total: 3024 patients).

Citation: Parasa S, Desai M, Chandrasekar VT, 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. 2020 Jun 1;3(6):e2011335.

In this rapid review, the authors searched for observational studies of gastrointestinal manifestations of COVID-19 infection. They did not restrict their searches by language of publication and searched up to 30 March 2020. They included 21 publications and 8 preprint studies from China (28) and a multicenter CDC database (1) (total: 4805 patients), and noted marked variation among the included studies.

Citation: Santos VS, Gurgel RQ, Cuevas LE, et al. Prolonged fecal shedding of SARS-CoV-2 in pediatric patients. A quantitative evidence synthesis. Journal of Pediatric Gastroenterology and Nutrition. 2020 Aug;71(2):150-2.

In this rapid review, the authors searched for observational studies comparing faecal viral shedding to respiratory viral shedding in paediatric patients with COVID-19 infection. They did not restrict their searches by language of publication and searched up to 19 April 2020. They included 4 studies (total: 36 paediatric participants), all of which they assessed as low-quality evidence.

Citation: Youssef M, Hussein M, Attia AS, et al. COVID‐19 and Liver Dysfunction: a systematic review and meta‐analysis of retrospective studies. Journal of Medical Virology. 2020 May 23.

In this rapid review, the authors searched for studies of acute liver injuries in COVID-19 patients. They did not restrict their searches by language of publication and searched up to 16 April 2020. They included 20 retrospective observational studies from China (total: 3428 patients), and noted variation among the included studies.

Citation: Sultan S, Altayar O, Siddique SM, et al. AGA Institute Rapid Review of the Gastrointestinal and Liver Manifestations of COVID-19, Meta-Analysis of International Data, and Recommendations for the Consultative Management of Patients with COVID-19. Gastroenterology 2020 Jul;159(1):320-34.e27.

In this rapid review, the authors searched for studies of gastrointestinal and liver manifestations of COVID-19 infection, and evidence of gastrointestinal complications associated with some COVID-19 treatments (antimalarial and antiviral treatments). They did not restrict their searches by language of publication and searched up to 5 April 2020, and monitored American journals up to 19 April 2020. They included 57 studies (total: 10,890 patients) and noted marked variation among the included studies.

Citation: Samidoust P, Samidoust A, Samadani AA, et al. Risk of hepatic failure in COVID-19 patients. A systematic review and meta-analysis. Le Infezioni in Medicina. 2020 Jun 1;28(suppl 1):96-103.

In this rapid review, the authors searched for studies of liver failure in patients with COVID-19 infection. They did not restrict their searches by language of publication and searched up to 3 April 2020. They included 21 studies (total: 4191 patients) and noted marked variation among the included studies.

Other reviews of this topic:

Citation: Wong MC, Huang J, Lai C, et al. Detection of SARS-CoV-2 RNA in fecal specimens of patients with confirmed COVID-19: a meta-analysis. Journal of Infection. 2020 Aug 01;81(2):E31-8.

Citation: Xin S, Xu J, Yu Y. Abnormal Liver Function Tests of patients with Coronavirus disease 2019 in Mainland China: a systematic review and meta-analysis. Journal of Gastrointestinal and Liver Diseases 2020 Jun 3;29(2):219-26.

 

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