An analysis of data from the Hong Kong cohort of patients with COVID-19 and a meta-analysis of findings from publications found that 17.6% of patients with COVID-19 had gastrointestinal symptoms. This Gastroenterology study also reports that virus RNA was detected in stool samples from 48.1% patients—even in stool collected after respiratory samples tested negative.
COVID-19 has been characterized by fever, respiratory, and gastrointestinal symptoms as well as shedding of virus RNA into feces. To get an overall picture of the extent of the gastrointestinal effects of SARS-CoV-2 infection, Ka Shing Cheung et al performed a systematic review and meta-analysis of published symptoms and detection of virus in stool, and also summarized data from a cohort of patients with COVID-19 in Hong Kong.
The authors found that, among the 59 patients with COVID-19 in Hong Kong, 15 patients (25.4%) had gastrointestinal symptoms and 9 patients (15.3%) had stool that tested positive for virus RNA. Stool viral RNA was detected in 38.5% of patients with diarrhea and 8.7% of patients without diarrhea. The median fecal viral load was 5.1 log10cpm in patients with diarrhea vs 3.9 log10cpm in patients without diarrhea.
In the authors’ meta-analysis of 60 studies, comprising 4243 patients, the pooled prevalence of all gastrointestinal symptoms was 17.6%. A higher proportion of patients with severe disease had symptoms (17.1%) than of patients with 11.8% of patients with non-severe COVID-19 (11.8%). SARS-CoV-2 binds to the angiotensin converting enzyme 2 (ACE2) to enter epithelial cells in the intestinal and respiratory tracts.
In the meta-analysis, the pooled prevalence of stool samples that were positive for virus RNA was 48.1%. Of these samples, 70.3% of those collected after loss of virus from respiratory specimens tested positive for the virus.
The authors propose that anyone exposed to feces from patients with COVID-19 exercise caution—even during patient recovery.