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New Study Suggests Digestive Issues Can Be First Sign of COVID-19

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Article updated March 30, 2020

A study published in The American Journal of Gastroenterology reported that some people who get the coronavirus will experience digestive symptoms like diarrhea as a first sign of the virus. A new study published in the same journal on March 30 reached a similar conclusion, highlighting the need to consider a broader range of COVID-19 symptoms.

COVID-19 is a new-to-humans coronavirus that primarily attacks the lungs and respiratory system. Its primary symptoms include fever, cough, shortness or breath and, if the infection worsens, chest pain, pneumonia and difficulty breathing. As medicals experts around the world race to learn new information, however, the list of the symptoms expands.

The first study published in the American Journal of Gastroenterology looked at data from 204 patients with COVID-19 in China’s Hubei province. Researchers found that 48.5% of these patients arrived at the hospital with digestive symptoms such as loss of appetite, diarrhea, vomiting, or abdominal pain. The study suggested digestive symptoms may present before the respiratory symptoms of COVID-19. Those with digestive symptoms included in this study also had a more severe course of illness.

A follow-up study looked at 206 patients who had a milder case of COVID-19, 48 who presented with only digestive symptoms, 69 with digestive and respiratory symptoms and 89 with only respiratory symptoms. Researchers found that of those with digestive symptoms, 67% experience diarrhea, 20% of whom had diarrhea before showing any other signs of COVID-19. Approximately a third of those who had digestive symptoms did not present with a fever. Those with digestive symptoms were also more likely to be contagious for longer.

Both study’s findings add additional evidence to mounting suspicion that COVID-19 causes gastrointestinal symptoms for some people. A case report published in the New England Journal of Medicine on the first known COVID-19 patient in the United States, for example, noted the patient experienced loose stool and abdominal discomfort during their second day of hospitalization. Other research has found evidence the virus is shed in fecal matter, similar to other coronaviruses like SARS and MERS.

While more research is needed to understand the role and impact of digestive symptoms in those who get COVID-19, the journal’s editor pointed out that both of these studies can help identify people with milder cases sooner for earlier treatment and to prevent the spread of the virus.

“This study is vital because it represents the 80% or more of patients who do not have severe or critical disease,” Brennan M.R. Spiegel, M.D., co-editor-in-chief of the American Journal of Gastroenterology, said in a press release. “This is about the more common scenario of people in the community struggling to figure out if they might have COVID-19 because of new-onset diarrhea, nausea or vomiting.”

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Header image via Ani Kolleshi/Unsplash



Originally published: March 18, 2020
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