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

Since the start of a pandemic from Wuhan, China in 2019, there is tremendous attention in 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.

For that we searched literature in MEDLINE, Scopus, Web of Science, and Embase. Also, the medRxiv was searched for preprints. The search was performed by using the following keywords "Covid-19", "Coronavirus", "SARS-CoV-2 infection", "SARS-CoV-2", "Gastrointestinal", "Gastrointestinal Tract", "digestive system". All the studies were conducted based on the PRISMA criteria.

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 our 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) did have significant effect on prevalence of any Gastrointestinal symptoms.

The anorexia, diarrhea, nausea, and vomiting are the most common Gastrointestinal presentations. The majorities of studies are in the Case series setting and conducted in China.