Gastrointestinal Manifestations of Coronavirus Disease 2019 Across the United States: A Multicenter Cohort Study

Ankur P. Patel, Troy K. Sanders, Preeti Prakash, Jade Law, Sujay Alvencar, Alyssa Choi, Janaki Shah, Karishma Patel, Padmavathi Srivoleti, Kirtan Chauhan, Simcha Weissman, Erik Holzwanger, Rohit Dhingra, Michelle Nguyen, Daniel Kim, Tahnee Sidhu, Christopher Stallwood, Aaron Dickstein, Nimisha Parekh, Osama AltayarMatthew A. Ciorba, Jessica Yu, Lea Ann Chen, James H. Tabibian, Berkeley N. Limketkai

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Background and Aims: Gastrointestinal (GI) symptoms occur among patients diagnosed with coronavirus disease 2019 (COVID-19), and there is clear evidence that SARS-CoV-2, the causative pathogen, infects the GI tract. In this large, multicenter cohort study, we evaluated variations in gastrointestinal and hepatic manifestations of COVID-19 throughout the United States (US). Methods: Patients hospitalized with a positive COVID-19 test prior to October 2020 were identified at 7 US academic centers. Demographics, presenting symptoms, laboratory data, and hospitalization outcomes were abstracted. Descriptive and regression analyses were used to evaluate GI manifestations and their potential predictors. Results: Among 2031 hospitalized patients with COVID-19, GI symptoms were present in 18.9%; diarrhea was the most common (15.2%), followed by nausea and/or vomiting (12.6%) and abdominal pain (6.0%). GI symptoms were less common in the Western cohort (16.0%) than the Northeastern (25.6%) and Midwestern (26.7%) cohorts. Compared to nonintensive care unit (ICU) patients, ICU patients had a higher prevalence of abnormal aspartate aminotransferase (58.1% vs 37.3%; P <.01), alanine aminotransferase (37.5% vs 29.3%; P =.01), and total bilirubin (12.7% vs 9.0%; P <.01). ICU patients also had a higher mortality rate (22.7% vs 4.7%; P <.01). Chronic liver disease was associated with the development of GI symptoms. Abnormal aspartate aminotransferase or alanine aminotransferase was associated with an increased risk of ICU admission. Conclusion: We present the largest multicenter cohort of patients with COVID-19 across the United States. GI manifestations were common among patients hospitalized with COVID-19, although there was significant variability in prevalence and predictors across the United States.

Original languageEnglish
Pages (from-to)909-915
Number of pages7
JournalGastro Hep Advances
Issue number6
StatePublished - Jan 2022


  • COVID-19
  • Coronavirus Disease 2019
  • Gastrointestinal
  • SARS-CoV-2


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