Beware: Gastrointestinal symptoms can be a manifestation of COVID-19()

BACKGROUND: There is a growing number of reports of COVID-19 cases presenting gastrointestinal (GI) symptoms. AIMS: To review studies reporting GI symptoms among COVID-19 patients. RESULTS: Fifteen papers (2800 patients) were identified. Frequency of GI symptoms varied from 3.0% to 39.6%, including diarrhea: 7.5%, nausea: 4.5%, anorexia: 4.4%, vomiting: 1.3%, abdominal pain: 0.5%, belching/reflux: 0.3%. These may be the first manifestation of COVID-19, however, there is controversy whether these reflect better or worst prognosis. Finally, the potential relationship with the angiotensin converting enzyme 2 (ACE2) cell receptor in the digestive tract as the virus entry route, is discussed. CONCLUSIONS: GI symptoms may be common in COVID-19 and may be the first manifestation before fever and respiratory symptoms. Therefore, clinicians and gastroenterologists need to be aware of these atypical cases during the current pandemic and of the fecal–oral transmission, and preventive measures may be implemented.