Nearly one in five COVID-19 patients may show only gastrointestinal symptoms; CT scans can aid early detection
The researchers did a systematic review of 469 published studies since the beginning of the pandemic to July 2020 and selected 36 of these studies for qualitative synthesis
At the beginning of the COVID-19 pandemic, only a few symptoms of this viral infection were identified globally: fever, dry cough and shortness of breath. As our understanding of the disease increased, so did the number of symptoms associated with COVID-19 . Soon, gastrointestinal symptoms of COVID-19 were recognised and their impact became known.
COVID-19 gastrointestinal symptoms
A study published in March 2020 revealed that patients of COVID-19 who had gastrointestinal symptoms may have worse clinical outcomes than those who don’t have stomach or digestive issues. Another study published in Translational Research indicates that SARS-CoV-2 can cause gastrointestinal symptoms like lack of appetite, vomiting, diarrhea and abdominal pain during the early phases of the disease.
Such intestinal dysfunction, the study says, induces changes in gut microbiota and increases the levels of inflammatory cytokines, making the disease worse. So, diagnosing gastrointestinal symptoms, especially ones that precede respiratory symptoms during COVID-19 , may be needed for early diagnoses and timely treatment.
A new study published in Abdominal Radiology supports the need for such focus on gastrointestinal symptoms of COVID-19 due to its alarming findings.
The alarming rate of gastrointestinal symptoms
The researchers did a systematic review of 469 published studies since the beginning of the pandemic to July 2020 and selected 36 of these studies for qualitative synthesis. The key findings of this study were recognizing the alarming rates at which gastrointestinal symptoms show up in COVID-19 patients. The researchers behind this study found that the prevalence of gastrointestinal symptoms among COVID-19 patients is 18 percent, while 16 percent of COVID-19 cases may only present with gastrointestinal symptoms.
This means that almost one in five COVID-19 patients may present with no other symptoms during the early stages of the disease other than gastrointestinal ones. So, how can these symptoms be observed early to make proper diagnosis possible? The study suggests that these symptoms indicate significant changes in the gastrointestinal tract, all of which can be observed through abdominal CT scans and imaging.
Abdominal CT scans for COVID-19 diagnosis
The researchers found that 21 of the 36 studies investigated abnormal abdominal imaging findings in patients who tested positive for SARS-CoV-2 and found that most patients presented with thickening of the bowel walls, hyperemia (increased blood flow to the intestines) and even fibrin clots in some cases. These changes in the gastrointestinal system indicate higher risks of cytokine storm, inflammation, swelling and ischemia or blockages in blood supply: all factors contributing to the worsening of COVID-19 infection.
Other imaging features of COVID-19 observed by abdominal radiologists are a fluid-filled colon, pneumatosis (gas in the bowel walls, which is an early predictor of enterocolitis), pneumoperitoneum (presence of gas in the abdominal cavity), intussusception (a rare and serious disorder where one part of the intestine slides inside another one) and ascites (the abnormal retention of fluid in the abdomen).
The researchers, therefore, suggest that abdominal radiologists should keep an eye out for these signs while imaging patients at risk of COVID-19 so that the infection is diagnosed in time and proper treatment is provided. Given the alarming rates of the presentation of only gastrointestinal symptoms among COVID-19 patients, this recommendation can be easily adopted globally to track and treat cases better.
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