Factors Associated with the Development of Gastrointestinal Symptoms in Patients Hospitalized with Covid-19

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Background and Aims: The most common symptoms of Covid-19 are respiratory; however, gastrointestinal symptoms are present in up to 50% of patients. We aimed to determine characteristics associated with the development of gastrointestinal symptoms in patients with Covid-19. Methods: A case–control study of adults hospitalized for Covid-19 was conducted across a geographically diverse alliance of 36 US and Canadian medical centers. Data were manually abstracted from electronic health records and analyzed using regression analyses to determine characteristics associated with any gastrointestinal symptoms and diarrhea specifically. Results: Of 1406 patients, 540 (38%) reported at least one gastrointestinal symptom and 346 (25%) reported diarrhea. Older patients (≥ 80 years) had significantly lower rates of any gastrointestinal symptoms and diarrhea (vs. patients 18–79 years, OR 0.41, p < 0.01 and OR 0.43 p = 0.01, respectively), while those with IBS (OR 7.70, p = 0.02 and OR 6.72, p < 0.01, respectively) and on immunosuppressive therapy (OR = 1.56, p = 0.02) had higher rates of any gastrointestinal symptom and diarrhea. Patients with constitutional symptoms exhibited significantly higher rates (OR 1.91, p < 0.01), while those with pulmonary disease alone had lower rates of gastrointestinal symptoms (OR 0.23, p = 0.01). A significant interaction between constitutional symptoms and pre-existing pulmonary conditions was observed. Conclusions: Several patient- and disease-specific characteristics associate with gastrointestinal symptoms in patients with Covid-19. Knowledge of these may provide insights into associated pathophysiologic mechanisms, and help health care professionals provide targeted attention to reduce morbidity related to Covid-19.

Original languageEnglish
Pages (from-to)3860-3871
Number of pages12
JournalDigestive Diseases and Sciences
Issue number8
StatePublished - Aug 2022

Bibliographical note

Funding Information:
This research is not sponsored by any government or private sponsoring agency or institution. Writing committee: Olga C. Aroniadis MD MSc, Xianling Wang, Tang Gong, Nauzer Forbes MD MSc, Jeong Yun Yang MD, Andrew Canakis DO, B. Joseph Elmunzer MD MSc, Dhiraj Yadav, MD, MPH. Steering Committee: B. Joseph Elmunzer MD (Chair), Rebecca L. Spitzer MPH, Rebekah E. Dixon BS, Collins O. Ordiah MBBS, Jennifer M. Kolb MD, MS, Sachin Wani MD, Olga C. Aroniadis MD, MSc, Robin B. Mendelsohn MD, Christopher J. DiMaio MD, Don C. Rockey MD, Amit G. Singal MD, MS, Amar R. Deshpande MD, Swati Pawa MD, Darwin L. Conwell MD, MSc, Raman Muthusamy MD, MAS, William M. Tierney MD, Dhiraj Yadav MD, MPH. Statisticians: Xianling Wang, Tang Gong. Data Coordinating Center: Teldon B. Alford BA, Lauren Wakefield MHA, Haley Nitchie MHA, Collins O. Ordiah MBBS, Rebecca L. Spitzer MPH. Emory University: Ambreen A. Merchant MBBS, Vaishali A. Patel MD, Field F. Willingham MD, MPH. Vanderbilt University: Eric F. Howard RN, BSN, Mary K. West RN, BSN, Casey L Koza BS, Patrick S. Yachimski MD. Grady Memorial Hospital: Emad Qayed MD, MPH, Rosemary Nustas MD. Ascension Providence Hospital/Michigan State University: Ali Zakaria MD, Marc S. Piper MD, MSc. Saint Louis University: Jason R. Taylor MD, Lujain Jaza MD. University of Calgary: Nauzer Forbes MD, MSc, Millie Chau BSc. The Ohio State University Wexner Medical Center: Luis F. Lara MD, Georgios I. Papachristou MD, PhD, Uchechi Okafor BSc, Darwin L. Conwell MD, MSc. Loma Linda University: Michael L. Volk MD, MSc, Evan Mosier MD, Mohamed Azab MD, Anish Patel MD. University of Southern California: Liam G. Hilson MD, Selena Zhou MD, James Buxbaum MD. Washington University School of Medicine: Vladimir M. Kushnir MD, Alexandria M. Lenyo BS, Ian P. Sloan BS, Thomas Hollander RN, BSN. Medical University of South Carolina: Caroline G. McLeod BS, Rebecca L. Spitzer MPH, Lauren Wakefield MHA, Haley Nitchie MHA, Collins O. Ordiah MBBS, MPH, Don C. Rockey MD, B. Joseph Elmunzer MD. University of Miami Miller School of Medicine: Sunil Amin MD, MPH, Gabriela N. Kuftinec MD, MPH, Amar R. Deshpande MD. University of Pittsburgh: Dhiraj Yadav MD, MPH, Melissa Saul MS, Melanie Mays BS, Gulsum Anderson PhD, Kelley Wood BS, Laura Mathews BS, Xianling Wang, Tang Gong. University of Colorado: Charlie Fox MD, Jennifer M. Kolb MD, MS, Sachin Wani MD. Wake Forest University School of Medicine: Swati Pawa MD, Rishi Pawa MD. Boston University: Andrew Canakis DO, Christopher Huang MD. Beaumont Health: Laith H. Jamil MD, Andrew M. Aneese MD, V. Mihajlo Gjeorgjievski, MD, Zaid Imam MD, Fadi Odish MD, Ahmed I. Edhi MD, Molly Orosey DO, Abhinav Tiwari MD, Soumil Patwardhan MBBS. University Hospitals of Cleveland Medical Center: Benita K. Glamour BA, Zachary L Smith DO, Amy E. Hosmer MD, Nancy Furey RN, BSN, MBA, Amitabh Chak MD. Northwestern University: Feinberg School of Medicine: Katherine A. Hanley MMS, PAC, Jordan Wood BS, Rajesh N. Keswani MD, MS. Ochsner Health: Harsh K. Patel MBBS, Janak N. Shah MD. Columbia University Medical Center: Emil Agarunov BS, Nicholas G. Brown MD, Anish A. Patel MD, Amrita Sethi MD. Indiana University School of Medicine: Evan L. Fogel MD, MSc, Gail McNulty RN, BSN. Loyola University Medical Center: Abdul Haseeb MD, Judy A. Trieu MD. Icahn School of Medicine at Mount Sinai: Rebekah E. Dixon BS, Jeong Yun Yang MD, Christopher J. DiMaio MD. Memorial Sloan Kettering Cancer Center: Robin B. Mendelsohn MD, Delia Calo MD. Renaissance School of Medicine at Stony Brook University: Olga C. Aroniadis MD, MSc, Joseph F. LaComb BS, Lilian Cruz BS, Olga Reykhart BS. University of Virginia Medical School: James M. Scheiman MD, Bryan G. Sauer MD, Galina Diakova MS. Henry Ford Health System: Duyen T. Dang MD, Cyrus R. Piraka MD. Dartmouth-Hitchcock Health and VA White River Junction: Eric D. Shah MD, MBA, Molly Caisse BS, Natalia H. Zbib MD, John A. Damianos MD, Heiko Pohl MD. University of Oklahoma Health Sciences Center: William M. Tierney MD, Stephanie Mitchell RN, Michael S. Bronze MD. David Geffen School of Medicine at UCLA: Ashwinee Condon MD, Adrienne Lenhart MD, Raman Muthusamy MD, MAS. Medical College of Wisconsin: Kulwinder S. Dua MD, Vikram S. Kanagala MD, James Esteban MD. Johns Hopkins Medical Institutions: Ayesha Kamal MD, Marcia I. Canto MD, Vikesh K. Singh MD, MS. McMaster University Hamilton Health Sciences: Maria Ines Pinto-Sanchez MD, MSc, Joy M. Hutchinson RD, MSc. Michigan Medicine: Richard S. Kwon MD, Sheryl J. Korsnes MA. University of Manitoba: Harminder Singh MD, MPH, Zahra Solati MSc, Nick Hajidiacos MD.

Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.


  • Characteristics
  • Covid-19
  • Gastrointestinal symptoms

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology


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