Review finds almost 20% of COVID-19 patients only show gastrointestinal symptoms

Almost one in five patients with COVID-19 may only show gastrointestinal symptoms, according to a review of academic studies published in the journal Abdominal Radiology. The findings of the review suggest abdominal radiologists need to remain vigilant during the pandemic while imaging patients.

Gastrointestinal symptoms associated with COVID-19 vary widely but can include loss of appetite, nausea, vomiting, diarrhea and generalized abdominal pain. The researchers who conducted the review report that 18 per cent of patients presented with such symptoms, while 16 per cent of COVID-19 cases may only present with gastrointestinal symptoms.

"There's a growing amount of literature showing that abdominal symptomatology is a common presentation for COVID-19," said Mitch Wilson, a radiologist and clinical lecturer in the University of Alberta's Faculty of Medicine & Dentistry.

The researchers, who also included Gavin Low, associate professor of radiology and diagnostic imaging, and medical student Kevin Lui, examined findings from 36 studies published through July 15 to reach their conclusions.

In addition to gastrointestinal symptoms, they also determined potential signs radiologists should look for while conducting abdominal imaging that could be evidence of COVID-19 infection. Those signs include inflammation of the small and large bowel, air within the bowel wall (pneumatosis) and bowel perforation (pneumoperitoneum). The signs are quite rare, said the researchers, and could indicate patients with advanced disease.

"Seeing these things is not necessarily telling us a patient has COVID-19," said Wilson. "It could be from a variety of potential causes. But one of those potential causes is infection from the virus, and in an environment where COVID-19 is very prevalent, it's something to consider and potentially raise as a possibility to the referring physician."