Gastrointestinal Manifestations of the COVID-19: A Systematic Review and MetaAnalysis with 111 studies

Saber Soltani; Armin Zakeri; Iraj Pakzad; Alireza Tabibzadeh; Amir Mohammad  Zakeri; Milad Zandi; Sara Akhavan Rezayat; Mehrzad Jafarzadeh; Parinaz  Khalkhali Asl; Arghavan Zebardast; Yousef Erfani; Ramin Shahbahrami; Reza Pakzad; Pooneh Malekifar

doi:10.18502/jbe.v7i4.10389

Saber Soltani Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Armin Zakeri Department of Hematology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
Iraj Pakzad Department of Microbiology, School of Medicine, Ilam University Medical Sciences, Ilam, Iran.
Alireza Tabibzadeh Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Amir Mohammad Zakeri Pediatric Surgery Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Milad Zandi Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Sara Akhavan Rezayat Department of Health Care Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Mehrzad Jafarzadeh Endocrine research center, institute of Endocrinology and Metabolism, Iran University of Medical Science, Tehran, Iran.
Parinaz Khalkhali Asl Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Golestan, Iran.
Arghavan Zebardast Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Yousef Erfani Department of Medical Laboratory Sciences, School of Allied Medical Sciences, Tehran University Medical Sciences, Tehran, Iran.
Ramin Shahbahrami Research Center for Clinical Virology, Tehran University of Medical Sciences, Tehran, Iran.
Reza Pakzad Department of Epidemiology, Faculty of Health, Ilam University Medical Sciences, Ilam, Iran.
Pooneh Malekifar Department of Epidemiology, School of Public Health, Tehran University Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/jbe.v7i4.10389

Keywords: COVID-19; SARS-CoV-2; Gastrointestinal Tract; Systematic Review; Meta-Analysis.

Abstract

Introduction: Since the start of a pandemic from Wuhan, China in 2019, there is tremendous attention on the COVID-19 manifestation. One of the most important COVID-19 clinical presentations is gastrointestinal symptoms. The current systematic review study aims to focus on the implication of the gastrointestinal tract in patients infected with SARS-CoV-2.

Methods: We searched literature in MEDLINE, Scopus, Web of Science, and Embase to find related article by using the following keywords "COVID-19", "SARS-CoV-2 infection", "Gastrointestinal Tract", "digestive system". The heterogeneity of included studies was quantified with the I2 statistic. A random-effects model was used to estimate the pooled prevalence and a meta-regression method was utilized to investigate the factors affecting heterogeneity between studies.

Results: Of 3028 retrieved documents, 111 studies with 21126 COVID-19 cases were included. The prevalence of any Gastrointestinal symptoms was 17.22% (14.48 to 20.13). The prevalence of diarrhea was 13.75% (12.07 to 15.44), anorexia 27.41% (21.53 to 33.29) and Nausea/vomiting 8.11% (6.87 to 9.35). Furthermore, the prevalence of other symptoms in current study was fever 76.70% (73.42 to 79.83), cough 58.07% (54.59 to 61.52) and dyspnea/shortness of breath 24.63% (20.06 to 29.48). According to meta-regression results, age (p: 0.027) and fever (p<0.001) had significant effect on prevalence of any Gastrointestinal symptoms.

Conclusion: The anorexia, diarrhea, nausea, and vomiting are the most common Gastrointestinal presentations.