Digestive symptoms in COVID-19 patients with mild disease

COVID-19: Digestive symptoms in COVID-19 patients with mild disease. Spencer EA, Heneghan C.


Published on July 9, 2020

Reference Han C, Duan C, Zhang S, 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(6):916-923. 2020
Study type
Country China
Setting Hospital
Funding Details Non reported
Transmission mode Orofecal

Bottom Line

Among a group of hospitalised patients with low severity COVID-19, digestive symptoms were present in 57%. Patients with digestive symptoms were more likely to be fecal virus-positive than those with respiratory symptoms.

Evidence Summary

206 hospitalised patients diagnosed with low severity COVID-19 were identified, 117 of these presented with digestive symptoms.

Within the 117 experiencing digestive symptoms, 

  • 48 presented with a digestive symptom alone, 
  • 69 with both digestive and respiratory symptoms, 
  • 67 presented with diarrhoea, of whom 19.4% experienced diarrhoea as the first symptom in their illness course. 

Diarrhoea lasted from 1 to 14 days, with an average duration of 5.4 days and a frequency of 4.3 bowel movements per day. 

Concurrent fever was found in 62% of the patients with a digestive symptom. Patients with digestive symptoms presented for care later than those with respiratory symptoms (16.0 ± 7.7 vs 11.6 ± 5.1 days, P < 0.001). 

Patients with digestive symptoms had a longer duration between symptom onset and viral clearance (P < 0.001) and were more likely to be fecal virus-positive (73.3% vs 14.3%, P = 0.033) than those with respiratory symptoms.

What did they do?

The researchers identified COVID-19 patients with mild disease and one or more digestive symptoms (diarrhoea, nausea, and vomiting), with or without respiratory symptoms, 

These COVID-19 cases were compared with a group presenting solely with respiratory symptoms.  Patients were clinically followed up until they tested negative for COVID-19 on at least two sequential respiratory tract specimens collected ≥24 hours apart. 

Clinical features between those with digestive symptoms and those with respiratory symptoms were compared.

Study reliability

This is a case series and maybe subject to biases.

Clearly defined setting Demographic characteristics described Follow-up length was sufficient Transmission outcomes assessed Main biases are taken into consideration
Yes No Yes No No

About the authors

Carl Heneghan

Carl is Professor of EBM & Director of CEBM at the University of Oxford. He is also a GP and tweets @carlheneghan. He has an active interest in discovering the truth behind health research findings

Elizabeth Spencer

Dr Elizabeth Spencer; MMedSci, PhD. Epidemiologist, Nuffield Department for Primary Care Health Sciences, University of Oxford.