Diarrhea is the first sign of coronavirus in some patients, study finds


Some patients with COVID-19 have gastrointestinal symptoms, especially diarrhea, as the first sign of illness, new research shows.

Among this subset of patients – who suffer from mild illness overall – respiratory symptoms do not appear until later in the disease, and some never develop respiratory symptoms at all, the authors said.


The results are important because those who do not have classic COVID-19 symptoms – such as coughing, shortness of breath, and fever – may go undiagnosed and could potentially spread the disease to others, the researchers said.

However, they note that digestive problems are generally common and do not necessarily mean that someone has COVID-19. But doctors should recognize that sudden digestive symptoms in people with possible contact with COVID-19 “should at least prompt an examination of the disease,” the authors wrote in their article, published before printing on Monday 30 March in The American Journal of Gastroenterology. . “Failure to recognize these patients early and often can lead to the involuntary spread of the disease. “

The study is not the first to report digestive symptoms as a sign of COVID-19. For example, a study published March 18 in the same journal found that, of approximately 200 COVID-19 patients in three hospitals in Wuhan, China, approximately 50% reported at least one digestive symptom and 18% reported diarrhea, vomiting or abdominal pain. . However, this and other studies tended to focus on patients with severe illness rather than those with mild illness.

Some people do not develop respiratory symptoms.

Some people do not develop respiratory symptoms.

In the new study, the researchers analyzed information from 206 patients at the Union Hospital, Tongji Medical College in Wuhan, which has been designated as a COVID-19 patient hospital. To be included in the study, patients had to have a mild illness with no difficulty breathing or low oxygen levels in the blood.

Overall, 48 patients (23%) were admitted for digestive symptoms only, 89 (43%) for respiratory symptoms only and 69 (33%) for respiratory and digestive symptoms.

Of all the patients with digestive symptoms (117 patients), about 67 (58 percent) had diarrhea, and among them, 13 (20 percent) suffered from diarrhea as the first symptom of their disease. The patients’ diarrhea lasted from one to 14 days, with an average duration of five days, according to the report. About a third of patients with digestive symptoms have never had a fever.

The study found that patients with digestive symptoms tended to seek health care later than those with respiratory symptoms, on average 16 days after the onset of their symptoms, compared to 11 days for those with respiratory symptoms. People with digestive symptoms also took longer to clear the virus from their bodies (negative test for COVID-19), which takes about 41 days on average, compared to 33 days for people with only respiratory symptoms.

Finally, those with digestive symptoms were much more likely to see the new coronavirus, SARS-CoV-2, detected in their stool, with around 73% having positive stool samples, compared to 14% of those showing only symptoms. respiratory. This discovery suggests, but does not definitively confirm, that this virus infects the gastrointestinal tract, the authors said.

Overall, “These data emphasize that patients with recent onset diarrhea after possible contact with COVID-19 should be suspected of the disease, even in the absence of cough, shortness of breath, sore throat. or even fever, “concluded the authors. “Ideally, the COVID-19 test should be performed using respiratory and stool samples, if available. “


The authors noted that their study was relatively small and that larger studies are needed to further describe the digestive symptoms in patients with mild COVID-19.

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Originally posted on Live Science.


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