Papafragkakis
Charilaos Papafragkakis, MD
Gastroenterologist - Hepatologist

DIGESTIVE SYMPTOMS AND CORONAVIRUS INFECTION

28 Μαρ 2020 / #

Corona virus infection is caused by the severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) and the disease has been named COVID-19.

Transmission through direct contact or via air droplets from the mouth or nose of an infected individual is a commonplace. The higher risk of transmission is within approximately 1 meter from the infected person, however, the exact safety distance is still undetermined. Since the distance of transmission from one person to the other remains relatively arbitrary, a reasonable suggestion may be to keep at least a 2-meter distance from an infected person. There is also a lot of discussion about how long the virus lives on surfaces. Data is emerging that it may live up to 3 days (72 h) on surfaces.

There is data that the virus RNA can be identified by PCR in the stool and therefore may theoretically be transmitted through the fecal-oral route. Because it could also be present on surfaces like the toilet seats or door knobs, it is very important to practice meticulous hand washing every time we use a bathroom.

The main symptomatology of a person infected with the coronavirus is well established since the beginning of the pandemic. The majority of symptomatic patients have fever and cough. When dyspnea occurs, it is a worrisome sign.

Digestive symptoms initially were underestimated, but they seem to be very common. As a matter of fact, many patients present initially with diarrhea, anorexia, and vomiting and not necessarily with respiratory symptoms.

The following data data is from a multicenter study that was conducted in China, from January 18th to February 28th, 2020.

The average age of the patients with coronavirus infection was 53 years, 107 men and 97 women. The average time from symptom onset to hospital admission was about 8 days.

About 50% of the patients admitted to the hospital were found to have digestive symptoms, the majority alongside respiratory symptoms. Only a minority of patients presented with digestive symptoms alone, i.e. they did not have respiratory symptoms.

Patients who initially presented with digestive symptoms had a significantly longer time from the onset of symptoms to hospital admission. The digestive symptoms were decreased appetite, mild to moderate diarrhea up to 2-3 times a day in about 35%, vomiting in about 4% and abdominal pain in 2% of the cases.

The liver can be affected also. Liver transaminases may be elevated after viral insult on the liver cells. Usually the increase is mild to moderate but can be more pronounced in patients with digestive symptoms or those requiring ICU care.

Always remember that digestive symptoms such as diarrhea may be caused by numerous other viruses, bacteria, dietary reasons and even stress. Every diarrhea is not a coronavirus infection. Be vigilant but don’t go crazy. STAY HOME.

Haris Papafragkakis MD

References:
Pan L. et al. https://journals.lww.com/ajg/Documents/ COVID_Digestive_Symptoms_AJG_Preproof.pdf

Repici A. et al. https://www.giejournal.org/article/S0016-5107(20)30245-5/fulltext

Zhang C et al. https://www.thelancet.com/journals/langas/article/PIIS2468-1253(20)30057-1/ fulltext

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Huang C et al. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30183-5/ fulltext

van Doremalen, Bushmaker, Morris et al. https://www.nejm.org/doi/10.1056/NEJMc2004973

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