Digestive Manifestations in Patients Hospitalized With Coronavirus Disease 2019

B. Joseph Elmunzer; Rebecca L Spitzer; Lydia D Foster; Ambreen A Merchant; Eric F Howard; Vaishali A Patel; Mary K West; Emad Qayed; Rosemary Nustas; Ali Zakaria; Marc S Piper; Jason R Taylor; Lujain Jaza; Nauzer Forbes; Millie Chau; Luis F Lara; Georgios I Papachristou; Michael L Volk; Liam G Hilson; Selena Zhou; Vladimir M Kushnir; Alexandria M Lenyo; Caroline G McLeod; Sunil Amin; Gabriela N Kuftinec; Dhiraj Yadav; Charlie Fox; Jennifer M Kolb; Swati Pawa; Rishi Pawa; Andrew Canakis; Christopher Huang; Laith H Jamil; Andrew M Aneese; Benita K Glamour; Zachary L Smith; Katherine A Hanley; Jordan Wood; Harsh K Patel; Janak N Shah; Emil Agarunov; Amrita Sethi; Evan L Fogel; Gail McNulty; Abdul Haseeb; Judy A Trieu; Rebekah E Dixon; Jeong Yun Yang; Robin B Mendelsohn; Delia Calo; Olga C Aroniadis; Joseph F LaComb; James M Scheiman; Bryan G Sauer; Duyen T Dang; Cyrus R Piraka; Eric D Shah; Heiko Pohl; William M Tierney; Stephanie Mitchell; Ashwinee Condon; Adrienne Lenhart; Kulwinder S Dua; Vikram S Kanagala; Ayesha Kamal; Vikesh K Singh; Maria Ines Pinto-Sanchez; Joy M Hutchinson; Richard S Kwon; Sheryl J Korsnes; Harminder Singh; Zahra Solati; Field F Willingham; Patrick S Yachimski; Darwin L Conwell; Evan Mosier; Mohamed Azab; Anish Patel; James Buxbaum; Sachin Wani; Amitabh Chak; Amy E Hosmer; Rajesh N Keswani; Christopher J DiMaio; Michael S Bronze; Raman Muthusamy; Marcia I Canto; V. Mihajlo Gjeorgjievski; Zaid Imam; Fadi Odish; Ahmed I Edhi; Molly Orosey; Abhinav Tiwari; Soumil Patwardhan; Nicholas G Brown; Anish A Patel; Collins O Ordiah; Ian P Sloan; Lilian Cruz; Casey L Koza; Uchechi Okafor; Thomas Hollander; Nancy Furey; Olga Reykhart; Natalia H Zbib; John A Damianos; James Esteban; Nick Hajidiacos; Melissa Saul; Melanie Mays; Gulsum Anderson; Kelley Wood; Laura Mathews; Galina Diakova; Molly Caisse; Lauren Wakefield; Haley Nitchie; Akbar K Waljee; Weijing Tang; Yueyang Zhang; Ji Zhu; Amar R Deshpande; Don C Rockey; Teldon B Alford; Valerie Durkalski

doi:10.1016/j.cgh.2020.09.041

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Digestive Manifestations in Patients Hospitalized With Coronavirus Disease 2019

Journal article

Peer reviewed

Digestive Manifestations in Patients Hospitalized With Coronavirus Disease 2019

B. Joseph Elmunzer, Rebecca L Spitzer, Lydia D Foster, Ambreen A Merchant, Eric F Howard, Vaishali A Patel, Mary K West, Emad Qayed, Rosemary Nustas, Ali Zakaria, …

Clinical gastroenterology and hepatology

2020-10-01

DOI: https://doi.org/10.1016/j.cgh.2020.09.041

PMID: 33010411

Abstract

COVID-19

Digestive Manifestations

SARS-CoV-2

Gastrointestinal Symptoms

Hepatic Manifestations

The prevalence and significance of digestive manifestations in coronavirus disease 2019 (COVID-19) remain uncertain. We aimed to assess the prevalence, spectrum, severity, and significance of digestive manifestations in patients hospitalized with COVID-19. Consecutive patients hospitalized with COVID-19 were identified across a geographically diverse alliance of medical centers in North America. Data pertaining to baseline characteristics, symptomatology, laboratory assessment, imaging, and endoscopic findings from the time of symptom onset until discharge or death were abstracted manually from electronic health records to characterize the prevalence, spectrum, and severity of digestive manifestations. Regression analyses were performed to evaluate the association between digestive manifestations and severe outcomes related to COVID-19. A total of 1992 patients across 36 centers met eligibility criteria and were included. Overall, 53% of patients experienced at least 1 gastrointestinal symptom at any time during their illness, most commonly diarrhea (34%), nausea (27%), vomiting (16%), and abdominal pain (11%). In 74% of cases, gastrointestinal symptoms were judged to be mild. In total, 35% of patients developed an abnormal alanine aminotransferase or total bilirubin level; these were increased to less than 5 times the upper limit of normal in 77% of cases. After adjusting for potential confounders, the presence of gastrointestinal symptoms at any time (odds ratio, 0.93; 95% CI, 0.76–1.15) or liver test abnormalities on admission (odds ratio, 1.31; 95% CI, 0.80–2.12) were not associated independently with mechanical ventilation or death. Among patients hospitalized with COVID-19, gastrointestinal symptoms and liver test abnormalities were common, but the majority were mild and their presence was not associated with a more severe clinical course.

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Collaboration types: Domestic collaboration; International collaboration
Citation topics: 1 Clinical & Life Sciences; 1.104 Virology - General; 1.104.1353 Coronavirus
Web Of Science research areas: Gastroenterology & Hepatology
ESI research areas: Clinical Medicine

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Title: Digestive Manifestations in Patients Hospitalized With Coronavirus Disease 2019
Creators: B. Joseph Elmunzer - Division of Gastroenterology and Hepatology, Department of Medicine, Charleston, South Carolina
Rebecca L Spitzer - Division of Gastroenterology and Hepatology, Department of Medicine, Charleston, South Carolina
Lydia D Foster - Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
Ambreen A Merchant - Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Eric F Howard - Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
Vaishali A Patel - Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Mary K West - Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
Emad Qayed - Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Rosemary Nustas - Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Ali Zakaria - Division of Gastroenterology, Department of Medicine, Ascension Providence Hospital/Michigan State University, College of Human Medicine, Southfield, Michigan
Marc S Piper - Division of Gastroenterology, Department of Medicine, Ascension Providence Hospital/Michigan State University, College of Human Medicine, Southfield, Michigan
Jason R Taylor - Division of Gastroenterology and Hepatology, Department of Medicine, Saint Louis University, St. Louis, Missouri
Lujain Jaza - Division of Gastroenterology and Hepatology, Department of Medicine, Saint Louis University, St. Louis, Missouri
Nauzer Forbes - Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
Millie Chau - Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
Luis F Lara - Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
Georgios I Papachristou - Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
Michael L Volk - Division of Gastroenterology, Department of Medicine, Loma Linda University, Loma Linda, California
Liam G Hilson - Division of Gastroenterology, Department of Medicine, University of Southern California, Los Angeles, California
Selena Zhou - Division of Gastroenterology, Department of Medicine, University of Southern California, Los Angeles, California
Vladimir M Kushnir - Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
Alexandria M Lenyo - Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
Caroline G McLeod - Division of Gastroenterology and Hepatology, Department of Medicine, Charleston, South Carolina
Sunil Amin - Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
Gabriela N Kuftinec - Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
Dhiraj Yadav - Division of Gastroenterology and Hepatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Charlie Fox - Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
Jennifer M Kolb - Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
Swati Pawa - Division of Gastroenterology, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
Rishi Pawa - Division of Gastroenterology, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
Andrew Canakis - Section of Gastroenterology, Department of Medicine, Boston University Medical Center, Boston, Massachusetts
Christopher Huang - Section of Gastroenterology, Department of Medicine, Boston University Medical Center, Boston, Massachusetts
Laith H Jamil - Section of Gastroenterology and Hepatology, Department of Internal Medicine, Beaumont Health, Royal Oak, Michigan
Andrew M Aneese - Section of Gastroenterology and Hepatology, Department of Internal Medicine, Beaumont Health, Royal Oak, Michigan
Benita K Glamour - Division of Gastroenterology, Department of Medicine, University Hospitals of Cleveland Medical Center, Cleveland, Ohio
Zachary L Smith - Division of Gastroenterology, Department of Medicine, University Hospitals of Cleveland Medical Center, Cleveland, Ohio
Katherine A Hanley - Division of Gastroenterology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
Jordan Wood - Division of Gastroenterology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
Harsh K Patel - Department of Gastroenterology, Ochsner Health, New Orleans, Louisiana
Janak N Shah - Department of Gastroenterology, Ochsner Health, New Orleans, Louisiana
Emil Agarunov - Division of Gastroenterology, Department of Medicine, Columbia University Medical Center, New York, New York
Amrita Sethi - Division of Gastroenterology, Department of Medicine, Columbia University Medical Center, New York, New York
Evan L Fogel - Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
Gail McNulty - Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
Abdul Haseeb - Division of Gastroenterology and Nutrition, Department of Medicine, Loyola University Medical Center, Chicago, Illinois
Judy A Trieu - Division of Gastroenterology and Nutrition, Department of Medicine, Loyola University Medical Center, Chicago, Illinois
Rebekah E Dixon - The Dr. Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
Jeong Yun Yang - The Dr. Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
Robin B Mendelsohn - Gastroenterology, Hepatology and Nutrition service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
Delia Calo - Gastroenterology, Hepatology and Nutrition service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
Olga C Aroniadis - Division of Gastroenterology, Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
Joseph F LaComb - Division of Gastroenterology, Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
James M Scheiman - Division of Gastroenterology, Department of Medicine, University of Virginia Medical School, Charlottesville, Virginia
Bryan G Sauer - Division of Gastroenterology, Department of Medicine, University of Virginia Medical School, Charlottesville, Virginia
Duyen T Dang - Division of Gastroenterology, Department of Medicine, Henry Ford Health System, Detroit, Michigan
Cyrus R Piraka - Division of Gastroenterology, Department of Medicine, Henry Ford Health System, Detroit, Michigan
Eric D Shah - Section of Gastroenterology and Hepatology, Department of Medicine, Dartmouth-Hitchcock Health, Lebanon, New Hampshire
Heiko Pohl - Section of Gastroenterology and Hepatology, Department of Medicine, Dartmouth-Hitchcock Health, Lebanon, New Hampshire
William M Tierney - Section of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
Stephanie Mitchell - Section of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
Ashwinee Condon - Division of Gastroenterology, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
Adrienne Lenhart - Division of Gastroenterology, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
Kulwinder S Dua - Division of Gastroenterology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
Vikram S Kanagala - Division of Gastroenterology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
Ayesha Kamal - Division of Gastroenterology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland
Vikesh K Singh - Division of Gastroenterology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland
Maria Ines Pinto-Sanchez - Division of Gastroenterology, Department of Medicine, McMaster University Hamilton Health Sciences, Hamilton, Ontario, Canada
Joy M Hutchinson - Division of Gastroenterology, Department of Medicine, McMaster University Hamilton Health Sciences, Hamilton, Ontario, Canada
Richard S Kwon - Division of Gastroenterology and Hepatology, Department of Medicine, Michigan Medicine, Ann Arbor, Michigan
Sheryl J Korsnes - Division of Gastroenterology and Hepatology, Department of Medicine, Michigan Medicine, Ann Arbor, Michigan
Harminder Singh - Division of Gastroenterology and Hepatology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
Zahra Solati - Division of Gastroenterology and Hepatology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
Field F Willingham - Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Patrick S Yachimski - Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
Darwin L Conwell - Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
Evan Mosier - Division of Gastroenterology, Department of Medicine, Loma Linda University, Loma Linda, California
Mohamed Azab - Division of Gastroenterology, Department of Medicine, Loma Linda University, Loma Linda, California
Anish Patel - Division of Gastroenterology, Department of Medicine, Loma Linda University, Loma Linda, California
James Buxbaum - Division of Gastroenterology, Department of Medicine, University of Southern California, Los Angeles, California
Sachin Wani - Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
Amitabh Chak - Division of Gastroenterology, Department of Medicine, University Hospitals of Cleveland Medical Center, Cleveland, Ohio
Amy E Hosmer - Division of Gastroenterology, Department of Medicine, University Hospitals of Cleveland Medical Center, Cleveland, Ohio
Rajesh N Keswani - Division of Gastroenterology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
Christopher J DiMaio - The Dr. Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
Michael S Bronze - Section of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
Raman Muthusamy - Division of Gastroenterology, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
Marcia I Canto - Division of Gastroenterology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland
V. Mihajlo Gjeorgjievski - Section of Gastroenterology and Hepatology, Department of Internal Medicine, Beaumont Health, Royal Oak, Michigan
Zaid Imam - Section of Gastroenterology and Hepatology, Department of Internal Medicine, Beaumont Health, Royal Oak, Michigan
Fadi Odish - Section of Gastroenterology and Hepatology, Department of Internal Medicine, Beaumont Health, Royal Oak, Michigan
Ahmed I Edhi - Section of Gastroenterology and Hepatology, Department of Internal Medicine, Beaumont Health, Royal Oak, Michigan
Molly Orosey - Section of Gastroenterology and Hepatology, Department of Internal Medicine, Beaumont Health, Royal Oak, Michigan
Abhinav Tiwari - Section of Gastroenterology and Hepatology, Department of Internal Medicine, Beaumont Health, Royal Oak, Michigan
Soumil Patwardhan - Section of Gastroenterology and Hepatology, Department of Internal Medicine, Beaumont Health, Royal Oak, Michigan
Nicholas G Brown - Division of Gastroenterology, Department of Medicine, Columbia University Medical Center, New York, New York
Anish A Patel - Division of Gastroenterology, Department of Medicine, Columbia University Medical Center, New York, New York
Collins O Ordiah - Division of Gastroenterology and Hepatology, Department of Medicine, Charleston, South Carolina
Ian P Sloan - Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
Lilian Cruz - Division of Gastroenterology, Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
Casey L Koza - Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
Uchechi Okafor - Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
Thomas Hollander - Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
Nancy Furey - Division of Gastroenterology, Department of Medicine, University Hospitals of Cleveland Medical Center, Cleveland, Ohio
Olga Reykhart - Division of Gastroenterology, Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
Natalia H Zbib - Section of Gastroenterology and Hepatology, Department of Medicine, Dartmouth-Hitchcock Health, Lebanon, New Hampshire
John A Damianos - Section of Gastroenterology and Hepatology, Department of Medicine, Dartmouth-Hitchcock Health, Lebanon, New Hampshire
James Esteban - Division of Gastroenterology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
Nick Hajidiacos - Division of Gastroenterology and Hepatology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
Melissa Saul - Division of Gastroenterology and Hepatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Melanie Mays - Division of Gastroenterology and Hepatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Gulsum Anderson - Division of Gastroenterology and Hepatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Kelley Wood - Division of Gastroenterology and Hepatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Laura Mathews - Division of Gastroenterology and Hepatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Galina Diakova - Division of Gastroenterology, Department of Medicine, University of Virginia Medical School, Charlottesville, Virginia
Molly Caisse - Section of Gastroenterology and Hepatology, Department of Medicine, Dartmouth-Hitchcock Health, Lebanon, New Hampshire
Lauren Wakefield - Division of Gastroenterology and Hepatology, Department of Medicine, Charleston, South Carolina
Haley Nitchie - Division of Gastroenterology and Hepatology, Department of Medicine, Charleston, South Carolina
Akbar K Waljee - Division of Gastroenterology and Hepatology, Department of Medicine, Michigan Medicine, Ann Arbor, Michigan
Weijing Tang - Department of Statistics, University of Michigan, Ann Arbor, Michigan
Yueyang Zhang - Department of Statistics, University of Michigan, Ann Arbor, Michigan
Ji Zhu - Department of Statistics, University of Michigan, Ann Arbor, Michigan
Amar R Deshpande - Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
Don C Rockey - Division of Gastroenterology and Hepatology, Department of Medicine, Charleston, South Carolina
Teldon B Alford - Division of Gastroenterology and Hepatology, Department of Medicine, Charleston, South Carolina
Valerie Durkalski - Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
Publication Details: Clinical gastroenterology and hepatology
Publisher: Elsevier Inc
Academic Unit: Miller School of Medicine; UMMG Dept of Medicine - Gastroenterology
Language: English
Resource Type: Journal article
PMID: 33010411
Record Identifier: 991031576637102976