A recent study from China found that diarrhea was a prominent symptom among up to half of patients with COVID-19 during the outbreak in Wuhan.

The study, which was published in The American Journal of Gastroenterology, was conducted by researchers from the Wuhan Medical Treatment Expert Group for COVID-19.¹

Although patients with COVID-19 most commonly present with respiratory symptoms, approximately half of patients in the Wuhan outbreak presented with digestive symptoms as their chief complaint, according to the findings.

Patients involved in the study presented to 3 hospitals from January 18 to February 28, 2020. All patients were confirmed by real-time RT-PCR and were analyzed for clinical characteristics, laboratory data, and treatment. Data were followed up until March 5, 2020.

Overall, data from 204 patients were analyzed for the current study. The average age was 54.9 years old. In total, 48.5% presented to the hospital with digestive symptoms as their chief complaint.

The study also showed that those with digestive symptoms had a significantly longer time from onset to admission than patients without digestive symptoms (9 days versus 7.3 days, respectively).

“Clinicians should recognize that digestive symptoms, such as diarrhea, may be a presenting feature of COVID-19, and that the index of suspicion may need to be raised earlier in at-risk patients presenting with digestive symptoms rather than waiting for respiratory symptoms to emerge.” the researchers wrote in the study.¹

Patients who experienced digestive symptoms had a variety of manifestations, including anorexia (83.8%), diarrhea (29.3%), vomiting (.08%), and abdominal pain (0.4%). As the severity of the disease increased, digestive symptoms became more pronounced. Seven patients from the study with COVID-19 presented with digestive symptoms, but no respiratory symptoms.

Additionally, patients without digestive symptoms were more likely to be cured and discharged than patients with digestive symptoms (60% versus 34.3%), according to the data. Overall, laboratory data demonstrated no significant liver injury, although other studies have indicated signs of liver involvement. The researchers noted that more research is needed to understand the effect of COVID-19 on liver function.

“In this study, COVID-19 patients with digestive symptoms have a worse clinical outcome and higher risk of mortality compared to those without digestive symptoms, emphasizing the importance of including symptoms like diarrhea to suspect COVID-19 early in the disease course before respiratory symptoms develop,” Brennan MR Spiegel, MD, MSHS, FACG, co-editor-in-chief of The American Journal of Gastroenterology, said in a press release about the study.² “This may lead to earlier diagnosis of COVID-19, which can lead to earlier treatment and more expeditious quarantine to minimize transmission from people who otherwise remain undiagnosed.”