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Digestive Symptoms in COVID-19 Patients With Mild Disease Severity: Clinical Presentation, Stool Viral RNA Testing, and Outcomes

Our take —

Gastrointestinal symptoms in COVID-19 are not uncommon. In this group of patients in China, many of those with digestive symptoms at admission had no respiratory symptoms, and some experienced diarrhea as their initial symptom. Those with digestive symptoms may go longer before diagnosis and viral clearance relative to those without, but the study is too small to definitively conclude this.

Study design

Retrospective cohort

Study population and setting

The study included 206 patients (mean age 63 years, 56% female) with laboratory-confirmed COVID-19 with mild disease severity admitted to a single hospital in Wuhan, China from February 13 to February 29, 2020. Patients with one or more digestive symptoms at admission were matched to controls with only respiratory symptoms. After excluding those with missing data and those who remained in hospital by March 18, 2020, there were 48 patients with only digestive symptoms, 69 with digestive and respiratory symptoms, and 89 with only respiratory symptoms.

Summary of Main Findings

Of the 67 patients presenting with diarrhea, 13 (19.4%) experienced diarrhea as their first symptom. The mean duration of diarrhea was 5.4 days. Patients with digestive symptoms had longer mean times between symptom onset and hospital admission (16.0 days) compared to those with only respiratory symptoms (11.6 days). Patients with diarrhea also had a longer mean interval between symptom onset and viral clearance (41.0 days) relative to those without diarrhea (36.6 days). SARS-Cov-2 RNA was found in stool samples from 12/22 patients. Stool samples from those presenting with digestive symptoms were more likely to test positive than those without digestive symptoms (73% vs 14%).

Study Strengths

Follow-up duration was sufficient to estimate viral clearance timelines. A standardized questionnaire was employed for symptom ascertainment.


Though measurement of digestive symptoms at admission was made via chart review and standardized questionnaire, it was necessarily limited by patient recall. Misclassification from recall error could contribute to observed differences in the symptom-to-admission and symptom-to-clearance intervals. There was no prospective assessment of symptoms during hospital admission: patients without digestive symptoms at admission may have developed them later. The sample size was fairly small. Stool RNA testing was limited to a small number of patients and no information was presented on the criteria for selection.

Value added

This study highlights a subgroup of hospitalized COVID-19 patients with gastrointestinal symptoms, even in the absence of respiratory symptoms.