Some Covid-19 patients may only show gastrointestinal symptoms, new review suggests

  • A recent review has found that gastrointestinal (GI) symptoms may be the only ones in some Covid-19 cases.
  • The researchers also suggest certain signs of infection that could be picked up by radiologists.
  • This is not the first study to suggest a link between GI symptoms and Covid-19.

Radiologists have been urged to remain observant, as almost one in five Covid-19 patients may only display gastrointestinal (GI) symptoms, a new review of academic studies has found.

The 36 studies analysed by the research team from the University of Alberta's Faculty of Medicine and Dentistry were published in July.

The findings of the review were published in the journal Abdominal Radiology.

The researchers also discovered potential signs radiologists should look out for when performing abdominal imaging, as this could be evidence of Covid-19 infection, they wrote.

“Gastrointestinal manifestations and imaging manifestations of SARS-CoV-2 infection are increasingly reported and warrant specific attention during abdominal imaging,” the authors reported.

Some cases may only present with GI symptoms

The gastrointestinal symptoms associated with Covid-19 vary widely, the researchers indicated, but may include loss of appetite, nausea, vomiting, diarrhoea, and generalised abdominal pain.

Their review notes that 18% of patients presented with such symptoms, while 16% of cases may only present with GI symptoms.

Evidence of Covid-19 infection

In addition to gastrointestinal symptoms, the team also found potential signs radiologists should be on the alert for while carrying out abdominal imaging, as these may serve as evidence of Covid-19 infection.

Those signs include inflammation of the small and large bowel, air within the bowel wall (pneumatosis), and bowel perforation (pneumoperitoneum).

They also wrote that these signs are quite rare, and could indicate patients with advanced Covid-19 disease.

"Seeing these things is not necessarily telling us a patient has Covid-19," said co-author Mitch Wilson, a radiologist and clinical lecturer in the University of Alberta's Faculty of Medicine and Dentistry.

"It could be from a variety of potential causes. But one of those potential causes is infection from the virus, and in an environment where Covid-19 is very prevalent, it's something to consider and potentially raise as a possibility to the referring physician."

Previous studies, similar findings

Other studies that have also looked at these symptoms, such as this study published in BJS Society in August, found that all GI symptoms are linked to more severe Covid-19 disease cases, as well as intensive care unit (ICU) admission.

A UK study published in September in BMJ found that GI symptoms were common among the sample’s 992 children, and that this should "trigger tests for the virus".

Another Mexican study, which included a review of data of 2 800 patients, found that GI symptoms may be the first manifestation before fever and respiratory ones.

The authors of this study cautioned that clinicians and gastroenterologists need to be aware of these atypical cases during the pandemic, so that preventive measures may be implemented.

READ | Seven different 'forms of disease' identified in mild Covid-19 cases – study

READ | Many Covid-19 cases are asymptomatic – but how does this happen?

READ | OPINION | Covid-19: A global survey shows worrying signs of vaccine hesitancy

Image: Getty/Malte Mueller

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