Gastrointestinal Manifestations of Coronavirus Disease 2019 Across the United States: A Multicenter Cohort Study

Ankur P Patel; Troy K Sanders; Preeti Prakash; Jade Law; Sujay Alvencar; Alyssa Choi; Janaki Shah; Karishma Patel; Padmavathi Srivoleti; Kirtan Chauhan; Simcha Weissman; Erik Holzwanger; Rohit Dhingra; Michelle Nguyen; Daniel Kim; Tahnee Sidhu; Christopher Stallwood; Aaron Dickstein; Nimisha Parekh; Osama Altayar; Matthew A Ciorba; Jessica Yu; Lea Ann Chen; James H Tabibian; Berkeley N Limketkai

doi:10.1016/j.gastha.2022.07.002

Gastrointestinal Manifestations of Coronavirus Disease 2019 Across the United States: A Multicenter Cohort Study

Gastro Hep Adv. 2022;1(6):909-915. doi: 10.1016/j.gastha.2022.07.002. Epub 2022 Jul 19.

Authors

Ankur P Patel^{1

2}, Troy K Sanders¹, Preeti Prakash¹, Jade Law³, Sujay Alvencar⁴, Alyssa Choi⁵, Janaki Shah⁶, Karishma Patel⁷, Padmavathi Srivoleti⁸, Kirtan Chauhan^{2

9}, Simcha Weissman¹⁰, Erik Holzwanger⁴, Rohit Dhingra⁴, Michelle Nguyen⁴, Daniel Kim⁵, Tahnee Sidhu⁸, Christopher Stallwood⁸, Aaron Dickstein⁴, Nimisha Parekh⁵, Osama Altayar⁶, Matthew A Ciorba⁶, Jessica Yu⁷, Lea Ann Chen¹¹, James H Tabibian^{1

3}, Berkeley N Limketkai^{1

12}

Affiliations

¹ Vatche & Tamar Manoukian Division of Digestive Diseases, UCLA School of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California.
² Department of Medicine, Baylor College of Medicine, Houston, Texas.
³ Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, California.
⁴ Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts.
⁵ Division of Gastroenterology, University of California Irvine, Irvine, California.
⁶ Inflammatory Bowel Diseases Center, Washington University in St. Louis, Saint Louis, Missouri.
⁷ Division of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, Oregon.
⁸ Department of Medicine, Saint Elizabeth's Medical Center, Brighton, Massachusetts.
⁹ Division of Gastroenterology and Hepatology, NYU Langone Health, New York, New York.
¹⁰ Department of Medicine, Hackensack University Medical Center, Hackensack, New Jersey.
¹¹ Division of Gastroenterology and Hepatology, Rutgers University New Brunswick, New Jersey.
¹² Vatche & Tamar Manoukian Division of Digestive Diseases, UCLA School of Medicine, Los Angeles, California.

Abstract

Background and aims: Gastrointestinal (GI) symptoms occur among patients diagnosed with coronavirus disease 2019 (COVID-19), and there is clear evidence that SARS-CoV-2, the causative pathogen, infects the GI tract. In this large, multicenter cohort study, we evaluated variations in gastrointestinal and hepatic manifestations of COVID-19 throughout the United States (US).

Methods: Patients hospitalized with a positive COVID-19 test prior to October 2020 were identified at 7 US academic centers. Demographics, presenting symptoms, laboratory data, and hospitalization outcomes were abstracted. Descriptive and regression analyses were used to evaluate GI manifestations and their potential predictors.

Results: Among 2031 hospitalized patients with COVID-19, GI symptoms were present in 18.9%; diarrhea was the most common (15.2%), followed by nausea and/or vomiting (12.6%) and abdominal pain (6.0%). GI symptoms were less common in the Western cohort (16.0%) than the Northeastern (25.6%) and Midwestern (26.7%) cohorts. Compared to nonintensive care unit (ICU) patients, ICU patients had a higher prevalence of abnormal aspartate aminotransferase (58.1% vs 37.3%; P < .01), alanine aminotransferase (37.5% vs 29.3%; P = .01), and total bilirubin (12.7% vs 9.0%; P < .01). ICU patients also had a higher mortality rate (22.7% vs 4.7%; P < .01). Chronic liver disease was associated with the development of GI symptoms. Abnormal aspartate aminotransferase or alanine aminotransferase was associated with an increased risk of ICU admission.

Conclusion: We present the largest multicenter cohort of patients with COVID-19 across the United States. GI manifestations were common among patients hospitalized with COVID-19, although there was significant variability in prevalence and predictors across the United States.

Keywords: ALT, alanine aminotransferase; AST, aspartate aminotransferase; BMI, body mass index; CI, confidence interval; COVID-19; COVID-19, coronavirus disease 2019; Coronavirus Disease 2019; GI, gastrointestinal; Gastrointestinal; ICU, intensive care unit; OR, odds ratio; SARS-CoV-2; SD, standard deviation; UCLA, University of California Los Angeles; aOR, adjusted odds ratio.

Grants and funding

K23 DK119544/DK/NIDDK NIH HHS/United States