Gastrointestinal features in COVID-19 and the possibility of faecal transmission.

Gastrointestinal features in COVID-19 and the possibility of faecal transmission. Spencer EA, Heneghan C.

Published on July 13, 2020

Reference Tian Y, Rong L, Nian W, He Y. Review article: gastrointestinal features in COVID-19 and the possibility of faecal transmission. Aliment Pharmacol Ther. 2020;51(9):843-851.  2020
Study type
Country Mostly China
Setting Review
Funding Details Non reported
Transmission mode Orofecal

Bottom Line

Gastrointestinal symptoms are common in COVID-19 patients and were observed with increased prevalence as the epidemic progressed in China. SARS-CoV-2 enters GI epithelial cells, and the faeces of COVID-19 patients are potentially infectious.

Evidence Summary

Among 2,033 COVID-19 patients, Gastrointestinal (GI) symptoms were observed in 3% (1/41) to 79% (159/201),cases

GI symptoms included anorexia 40%; diarrhoea 2%; vomiting 3.6%; nausea 1% ; abdominal pain 2.2%; and gastrointestinal bleeding 4% 

Adult and paediatric patients can present with digestive symptoms in the absence of respiratory symptoms. 

  • Diarrhoea was the most common gastrointestinal symptom in children and adults, with a mean duration of 4.1 ± 2.5 days, and was observed before and after diagnosis. 
  • Vomiting was more prominent in children. 

Angiotensin-converting enzyme 2 and virus nucleocapsid protein was detected in gastrointestinal epithelial cells, and infectious virus particles were isolated from faeces. 

Faecal PCR testing was as accurate as respiratory specimen PCR detection, and faecal excretion persisted after sputum excretion in 23% patients for 1 to 11 days.

What did they do?

This was a review of studies included data on confirmed COVID-19 cases with data on GI symptoms and faecal viral testing. Case reports and retrospective clinical studies published in English or Chinese language from the end of December 2019 to the end of February 2020 were included. Most studies included data for patients in China.

Study reliability

Included studies were case reports and retrospective case series, which are open to biases, and this review did not present an assessment of study quality. 

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

What else should I consider?

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.