Clinical Case Series of Gastrointestinal Symptoms in Patients with Novel Coronavirus 2019 (COVID-19) Infection

IMPORTANCE: Since the outbreak of coronavirus disease 2019 (COVID-19), various digestive symptoms have been frequently reported in a significant portion of patients infected with the virus. It is well established that most patients with COVID-19 have fever along with respiratory signs and symptoms, such as cough and dyspnea. We present 36 cases with chief complaint of gastrointestinal (GI) symptoms along with respiratory. Therefore, we aimed to further investigate the prevalence and outcomes of COVID-19 patients with digestive symptoms OBSERVATIONS: Variety of observed GI symptoms included nausea and vomiting (72.2%), diarrhea (25%), abdominal pain (19.4%), loss of appetite (14%), and anosmia (14%). The most non-GI symptoms were dyspnea (66.7%), fever (66.7%), dry cough (58.3%), myalgia (52.4%), and others. Six patients (16.6%) were critically ill, 7 (19.4%) were in stable condition, and 23 patients (64%) had moderate symptoms. Among all patients, 7 (19.5%) needed critical care and admitted in ICU room. Leucopenia, Lymphopenia, and elevated acute-phase proteins were other features of these patients. The most common antiviral regimen was hydroxychloroquine +oseltamivir. Finally, 32 patients (89%) were discharged and 4 (11%) died. CONCLUSIONS AND RELEVANCE: This case series study highlights that patients with COVID-19 are prone to GI symptoms along with fever and respiratory symptoms. In particular, patients may present with digestive symptoms without respiratory symptoms. Hence, clinicians should pay more attention to these patients and help diagnose COVID-19 earlier to start treatment promptly before occurrence of severe disease.