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  • Diarrhea is an uncommon gastrointestinal symptom in patients with COVID-19, but in may be the presenting symptom in few patients. The frequency of occurrence of diarrhea varies between 1%-35%. [1]It varies widely between different studies probably due to the different criteria used to define diarrhea.
  • Greater percentage of occurrence was noted in patients with severe COVID-19 when compared to non-severe disease. Likewise, patients with gastrointenstinal symptoms were more likely to have severe respiratory disease with ARDS requiring ventilatory support. [2] [3]

Pathophysiology

  • SARS-CoV-2 uses the Angiotensin-converting enzyme 2 (ACE2) and the serine protease TMPRSS2 receptors for cell entry. These receptors are presently abundantly not only in the lungs but also in the enterocytes of the small intestinal.[4][5] Other sites of expression of the receptors in the gastrointestinal tract are-the upper esophagus, liver, and colon. [4]
  • Entry of the virus causes disruption of the enterocytes and may lead to inflammation and alteration of intestinal permeability.
  • COVID- 19 is being treated by atrial of many different antivirals and antibiotics. Diarrhea could also be a result of an alteration of the gut microbiota due to any of these. [6]

Clinical Features of Diarrhea caused by SARS-CoV-2

  • According to Jin et al[2], the definition of diarrhea was the passing of loose stools >3 times per day.
  • According to this study, 8.1% had diarrhea at onset and the symptoms lasted for approximately 4 days.
  • The duration of diarrhea ranged from 2-4 days with 3-8 bowel movements per day, according to various studies. [7][8]

Treatment

  • Supportive management is the mainstay of treatment.
  • Rehydration, fluid repletion, and potassium monitoring are essential.
  • Use of probiotics may have a role if the diarrhea is being caused by alteration of the gut microbiome. This could also be potentially useful in preventing secondary bacterial infections by restoring the gut microbiota. [6]
  1. ↑ Li XY, Dai WJ, Wu SN, Yang XZ, Wang HG (2020). "The occurrence of diarrhea in COVID-19 patients". Clin Res Hepatol Gastroenterol. doi:10.1016/j.clinre.2020.03.017. PMC 7270575 Check |pmc= value (help). PMID 32253163 Check |pmid= value (help).
  2. ↑ 2.0 2.1 Jin X, Lian JS, Hu JH, Gao J, Zheng L, Zhang YM; et al. (2020). "Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms". Gut. 69 (6): 1002–1009. doi:10.1136/gutjnl-2020-320926. PMC 7133387 Check |pmc= value (help). PMID 32213556 Check |pmid= value (help).
  3. ↑ Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX; et al. (2020). "Clinical Characteristics of Coronavirus Disease 2019 in China". N Engl J Med. 382 (18): 1708–1720. doi:10.1056/NEJMoa2002032. PMC 7092819 Check |pmc= value (help). PMID 32109013 Check |pmid= value (help).
  4. ↑ 4.0 4.1 D'Amico F, Baumgart DC, Danese S, Peyrin-Biroulet L (2020). "Diarrhea During COVID-19 Infection: Pathogenesis, Epidemiology, Prevention, and Management". Clin Gastroenterol Hepatol. doi:10.1016/j.cgh.2020.04.001. PMC 7141637 Check |pmc= value (help). PMID 32278065 Check |pmid= value (help).
  5. ↑ Liang W, Feng Z, Rao S, Xiao C, Xue X, Lin Z; et al. (2020). "Diarrhoea may be underestimated: a missing link in 2019 novel coronavirus". Gut. 69 (6): 1141–1143. doi:10.1136/gutjnl-2020-320832. PMID 32102928 Check |pmid= value (help).
  6. ↑ 6.0 6.1 Gao QY, Chen YX, Fang JY (2020). "2019 Novel coronavirus infection and gastrointestinal tract". J Dig Dis. 21 (3): 125–126. doi:10.1111/1751-2980.12851. PMC 7162053 Check |pmc= value (help). PMID 32096611 Check |pmid= value (help).
  7. ↑ Song Y, Liu P, Shi XL, Chu YL, Zhang J, Xia J; et al. (2020). "SARS-CoV-2 induced diarrhoea as onset symptom in patient with COVID-19". Gut. 69 (6): 1143–1144. doi:10.1136/gutjnl-2020-320891. PMID 32139552 Check |pmid= value (help).
  8. ↑ Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J; et al. (2020). "A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster". Lancet. 395 (10223): 514–523. doi:10.1016/S0140-6736(20)30154-9. PMC 7159286 Check |pmc= value (help). PMID 31986261.
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