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COVID-19 and the gastrointestinal tract: more than meets the eye
  1. Siew C Ng1,
  2. Herbert Tilg2
  1. 1 Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong
  2. 2 Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology & Metabolism, Medical University Innsbruck, Innsbruck, Austria
  1. Correspondence to Professor Siew C Ng, Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Disease, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong; siewchienng{at}cuhk.edu.hk; Professor Herbert Tilg, Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology & Metabolism, Medical University Innsbruck, Innsbruck, Austria; herbert.tilg{at}i-med.ac.at

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An outbreak of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome (SARS-CoV-2), has rapidly spread from China to almost all over the world affecting over 800,000 people across 199 countries. Whereas typical presentations of this infection, such as fever, cough, myalgia, fatigue and pneumonia, are well recognised,1–4 early studies reported low incidence of typical gastrointestinal (GI) symptoms, such as diarrhoea in the range of 1%–3.8%.1–4 Another study suggested a higher rate of GI symptoms with diarrhoea and nausea in 10.1% and vomiting in 3.6%.5

In GUT several articles report on GI symptoms, detection of the virus in faeces and potential pathophysiological aspects including viral receptor expression in the GI tract.6–12 Two large clinical studies from China focused on GI symptoms and detection of the virus in faeces.6 7 Jin et al investigated 74 patients infected with SARS-CoV-2 with GI symptoms such as diarrhoea, nausea and vomiting. Up to 28% of those with GI symptoms did not have respiratory symptoms. Here, they showed that this patient group compared with patients without GI symptoms (n=577) had overall more severe/critical disease, more patients with fever >38.5°C, family clustering and higher rates of liver injury as assessed by elevated aspartate transaminase levels. Among the total studied SARS-CoV-2-infected patients (n=651) 11.4% experienced GI symptoms, that is, higher rates than reported in previous studies.6 In another study, Lin et al investigated 95 SARS-CoV-2-infected patients with special emphasis on GI symptoms.7 Overall, 58/95 cases (61.1%) showed evidence of GI symptoms with diarrhoea (24.2%), nausea (17.9%), vomiting (4.2%) …

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