COVID-19 Patients May Initially Present With Extrapulmonary Symptoms Such as Diarrhea

Gastrointestinal (GI) symptoms were reported to be the chief complaint in nearly half of patients diagnosed with coronavirus disease 2019 (COVID-19), according to the findings of a cross-sectional study conducted by the Wuhan Medical Treatment Expert Group for COVID-19 in China.

The study, which was recently published in The American Journal of Gastroenterology, analyzed data on 204 patients (107 men, 97 women) who were diagnosed with COVID-19 at 3 different hospitals in Hubei province between January 18, 2020 and February 28, 2020. The average age of the patients was 54.9 years (SD +15.4).

Findings of the study revealed that the time from symptom onset to hospital admission was significantly longer in patients with GI symptoms vs those without them (9.0 days versus 7.3 days, respectively). “This may indicate that patients presenting with digestive symptoms sought care later because they did not yet suspect COVID-19 in the absence of respiratory symptoms, like cough or shortness of breath,” the authors stated. 

The study also showed that patients experienced a variety of GI symptoms, including anorexia (83.8% of cases), diarrhea (29.3% of cases), vomiting (0.8% of cases), and abdominal pain (0.4% of cases). Seven patients reported experiencing GI symptoms but had no respiratory symptoms. 

Several associations between the presence of GI symptoms and the severity of COVID-19 were also observed during the study. One finding of the analysis showed that GI symptoms became more pronounced as the severity of COVID-19 increased. Another finding revealed that patients with GI symptoms were less likely to be cured and discharged compared to patients without GI symptoms (34.3% vs 60%, respectively). 

Related Articles

Brennan M.R. Spiegel, MD, MSHS, FACG, Co-Editor-in-Chief of The American Journal of Gastroenterology, stated, “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.”

According to the study authors, it is imperative that healthcare providers strongly consider GI symptoms as a potential presenting feature of COVID-19 in at-risk patients. This, in turn, could potentially lead to faster diagnosis and treatment of patients who may initially only present with extrapulmonary symptoms.


Pan L, et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study. The American Journal of Gastroenterology 10.14309/ajg.0000000000000620.