Gastrointestinal Manifestations Tied to Less COVID-19 Severe Outcomes

Young man having stomach ache, painful area highlighted in red
In a prospective study, researchers observed the effect of gastrointestinal symptoms on COVID-19 outcome.

Patients diagnosed with COVID-19 who presented with gastrointestinal (GI) symptoms had better outcomes compared with patients who did not have GI symptoms, according to study findings published in the Indian Journal of Medical Microbiology.

GI symptoms are commonly documented in patients with COVID-19. However, the clinical effect of these symptoms on COVID-19 outcome is mixed due to most data coming from retrospective studies. The objective of the current study was to assess the impact of GI symptoms on COVID-19 outcome in patients admitted to the hospital diagnosed with COVID-19.

The prospective, single-center study in India included 203 admitted patients diagnosed with COVID-19 who did not have any pre-existing GI conditions. Patients were categorized as having only respiratory symptoms, respiratory and GI symptoms, or only GI symptoms. A detailed history of symptoms, disease course, and disease outcomes were recorded for each participant.

Presentation with both respiratory and GI symptoms was the most common, followed by respiratory symptoms only, and GI symptoms only, at 57.6%, 24.1%, and 9.9%, respectively. Of the patients with GI symptoms, only 23% had GI symptoms at presentation, while the remainder of patients developed GI symptoms throughout the disease course. Nearly 60% of patients had more than 1 GI symptom, with diarrhea being the most common at 30%.

Patients with diarrhea had no mortality or mechanical ventilation, and lower rates of requiring intensive care compared with patients without diarrhea. After adjusting for multiple confounders, the presence of GI symptoms was a statistically significant negative predictor of moderate or severe disease (P =.004).

Study limitations included the lack of objective measurements like cytokine levels. Additionally, there are numerous unaccounted potential confounders for GI symptoms developed later in the clinical course.

While larger prospective studies would be beneficial to expand upon results, GI manifestations of COVID-19, most commonly diarrhea, appear to be associated with better outcomes and a more mild disease course.


Singh S, Samanta J, Suri V, et al. Presence of diarrhea associated with better outcomes in patients with COVID-19 – a prospective evaluation. Indian J Med Microbiol. Published online April 26, 2022. doi: 10.1016/j.ijmmb.2022.04.002

This article originally appeared on Gastroenterology Advisor