Prevalence of gastrointestinal symptoms and fecal viral shedding in patients with COVID-2019: a systematic review and meta-analysis.

Prevalence of gastrointestinal symptoms and fecal viral shedding in patients with COVID-2019: a systematic review and meta-analysis. Spencer EA, Heneghan C.

https://www.cebm.net/study/prevalence-of-gastrointestinal-symptoms-and-fecal-viral-shedding-in-patients-with-covid-2019-a-systematic-review-and-meta-analysis/

Published on July 9, 2020

Included in Transmission Dynamics of COVID-19

Reference	Parasa S, Desai M, Thoguluva Chandrasekar V, et al. Prevalence of gastrointestinal symptoms and fecal viral shedding in patients with coronavirus disease 2019: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(6):e2011335. Published 2020 Jun 1. 2020
Study type
Country	N/A
Setting	Mainly Hospital
Funding Details	Non reported
Transmission mode	Orofecal
Exposures

Bottom Line

This review reports that the Gastrointestinal tract supports the growth of SARS-CoV-2 to an extent similar to previous SARS infections and that gastric symptoms are frequently experienced in COVID-19.

Evidence Summary

29 relevant studies were included: 23 published and 6 preprints (most of the included studies were of moderate quality).

Approximately 12% of patients with SARS-CoV-2 infection reported gastrointestinal symptoms, including diarrhoea, nausea, and vomiting. SARS-CoV-2.

Eight studies reported the detection of viral RNA of SARS-CoV-2 in stool and the pooled analysis reported that RNA shedding in stool was detected in up to 41% of COVID-19 patients.

Liver enzyme levels outside reference ranges were observed in 15% to 20% of patients.

What did they do?

This was a systematic review and meta-analysis to estimate the incidence rates of gastrointestinal symptoms among patients with SARS-CoV-2. Methods were reported as follows:

The search was performed using MEDLINE/PubMed and Embase and preprint using bioRxiv and medRxiv from November 1st 2019 to March 30th 2020. The search terms included “COVID-19,” “SARS-Cov-2,” and/or “novel coronavirus.

Eligible studies were those including patients with SARS-CoV-2 infection who reported GI symptoms.

Data on patients with GI symptoms (ie, diarrhoea, nausea, or vomiting), liver enzyme level changes, and fecal shedding of the virus were extracted.

The quality of the studies was examined using the methodological index for nonrandomized studies. Pooled estimates were reported with 95% CIs with the level of heterogeneity (I2).

Study reliability

Most included studies were from China and were large case series or observational studies, which are subject to methodological biases. The quality of clinical data was often not clear in the included studies.

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

What else should I consider?

Study and Characteristics of the Included Studies

Source	Setting	Population	Patient numbers
Chen et al	Zhongnan Hospital, Wuhan, China	Pregnant women with laboratory-confirmed COVID-19 pneumonia	9
Zhang et al	Jinhua Hospital, China	Patients with laboratory-confirmed COVID-19 pneumonia	14
Wang et al	21 hospitals in 17 cities in, China	Children	31
Xiao et al	Guangzhou, China	Hospitalized patients with SARS-CoV-2 detected in stool	73
Ling et al	Shanghai, China	All patients with COVID-19 in Shanghai region	66
Liu et al	hospitals in Hubei province, China	Patients with COVID-19 admitted to the respiratory departments	137
Yang et al	Wenzhou, China	Patients with SARS-CoV-2 infection confirmed via RT-PCR	149
Xu et al	hospitals in Zhejiang, China	Hospitalized patients with laboratory-confirmed SARS-Cov-2	62
Liu et al	Jianghan University Hospital, Wuhan, China	Physicians and nurses	30
Guan et al	Wuhan, China	Adults with SARS-CoV-2 infection	1099
Huang et al	Wuhan, China	Adult patients	41
Chen et al	Wuhan, China	Adult patients	99
Wang et al	Zhongnan, Wuhan	Adult patients	138
Zhang et al	Fever clinic in Beijing, China	All patients	9
Chen et al	Wuhan, China	Patient admitted to the isolation ward	29
Wang et al	Shanghai, China	Patients receiving combined Chinese and Western medicine	4
Chang et al	Beijing, China	Hospitalized patients	13
Pan et al	Wuhan, China	Adult patients	204
Luo et al	Wuhan, China	Hospitalized patients	1141
Zhou et al	Wuhan, China	Medical staff and nonstaff patients	254
Jin et al	Zhijang province, China	Adult patients	651
Preprint studies
Zhang et al	Hubei, Shiyan, China	Patients aged 0-14 y	34
Qian et al	Wuhan, China	NA	91
Fan et al	Shanghai, China	Patients aged 15-88 y	148
Zhao et al	Hospital of University of Science and Technology of China	Patients aged 16-91 y	75
Han et al	Wuhan, China	Hospitalized patients aged 27-92 y	206
Xu et al	Guangzhou, China	Pediatric patients	10
Wu and McGoogan	Multicenter CDC database	72 314 case records	44 ,672
Liu et al	Union Hospital, Wuhan, China	Patients aged 23-63 y	64

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.