Frequency and Impact of Preadmission Digestive Symptoms on Outcome in Severe COVID-19: A Prospective Observational Cohort Study

Gastrointestinal symptoms among COVID-19 patients presenting to a primary health care center of Nepal: A cross-sectional study

Background and Aim

Coronavirus disease 2019 (COVID-19) is a major public health problem causing significant morbidity and mortality worldwide. Apart from respiratory symptoms, gastrointestinal symptoms like nausea, vomiting, diarrhea, and abdominal discomfort are quite common among COVID-19 patients. The gastrointestinal tract can be a potential site for virus replication and feces a source of transmission. Thus, ignorance of enteric symptoms can hinder effective disease control. The objective of this study is to see the gastrointestinal manifestation of the disease and its effect on morbidity and mortality.

Methods

This observational cross-sectional retrospective study was carried out among 165 laboratory-confirmed COVID-19 patients in primary health care of Gorkha, Nepal from March 1, 2021 to March 1, 2022. A systematic random sampling method was adopted while data were entered and analyzed by Statistical Package for Social Sciences version 21.

Results

Of 165 patients, 97 patients (58.78%) had enteric involvement. Among gastrointestinal symptoms, diarrhea in 67 patients (40.6%) and nausea and/or vomiting in 66 patients (40%) were the most common symptoms, followed by abdominal pain in 27 patients (16.4%) and anorexia in 19 patients (11.5%). Of the majority of cases with gastrointestinal involvement, 63 (63%) were below 50 years of age. Many of the patients who received vaccination had gastrointestinal symptoms (79%). Complications like acute respiratory distress syndrome, shock, and arrhythmia developed in 9.7% of patients, with the death of eight patients. COVID-19 vaccination was associated with 4.32 times higher odds of having gastrointestinal involvement in subsequent COVID-19 infection.

Conclusions

Diarrhea followed by nausea/vomiting was among the most common gastrointestinal symptoms affecting younger age groups in our study. Enteric symptoms were more common among vaccinated people rather than among nonvaccinated ones.

An Unusual Cause of Acute Abdominal Pain in Coronavirus Disease (COVID-19): Report of Two Cases

Coronavirus disease-2019 (COVID-19) is an infectious disease caused by coronavirus/2019-nCoV. It primarily manifests as lung infection, with fever and respiratory tract symptoms. Extrapulmonary complications affecting multiple organs are commonly seen, especially in critically ill patients. The reported gastrointestinal (GI) complications include transaminitis, acute pancreatitis, mesenteric ischemia, GI bleed, and ileus. Here, we report two cases of acute abdominal pain in patients with COVID-19 in their second week of illness. One patient had mild COVID-19 disease and the other had severe disease. Both patients had diffuse abdominal tenderness and raised inflammatory markers. The diagnosis of mesenteric panniculitis (MP) was made radiologically, and demonstrated with the presence of increased density of the mesentery with fat stranding (misty mesentery). Glucocorticoid administration resulted in the complete resolution of pain. They remained pain-free at 3 months of follow-up.