Gastrointestinal and hepatic abnormalities in patients with confirmed COVID-19: A systematic review and meta-analysis.

Background and aim Although not common, gastrointestinal and liver symptoms have reportedly been the initial presentation of COVID-19 in a large group of patients. Therefore, knowing the frequency and characteristics of these manifestations of COVID-19 is important for both clinicians and health policymakers. A systematic review and meta-analysis of the available data on the gastrointestinal and liver manifestations of COVID-19 patients was performed. Methods PubMed and Scopus databases and Google Scholar search engine were searched for published and unpublished preprint articles up to April 10, 2020. Original studies providing information on clinical digestive symptoms or biomarkers of liver function in patients with polymerase chain reaction confirmed diagnosis of COVID-19 were included. After quality appraisal, data were extracted. Prevalence data from individual studies were pooled using a random-effects model. Results Overall, 67 studies were included in this systematic review and meta-analysis, comprising a pooled population of 13,251 patients with confirmed COVID-19. The most common gastrointestinal symptoms were anorexia (10.2%, 95%CI=6.2-16.4%), diarrhea (8.4%, 95%CI=6.2-11.2%), and nausea (5.7%, 95%CI=3.7-8.6%), respectively. Decreased albumin levels (39.8%, 95%CI=15.3-70.8%), increased aspartate aminotransferase (22.8%, 95%CI=18.1-28.4%) and alanine aminotransferase (20.6%, 95%CI=16.7-25.1%) were common hepatic findings. After adjusting for pre-existing gastrointestinal (5.9%) and liver diseases (4.2%), the most common gastrointestinal findings were diarrhea (8.7%, 95%CI=5.4-13.9%), anorexia (8.0%, 95%CI=3.0-19.8%), and nausea (5.1%, 95%CI=2.2-14.3%). Conclusions Gastrointestinal and liver manifestations are not rare in patients with COVID-19, but their prevalence might be affected by pre-existing diseases. Diarrhea and mild liver abnormalities seem to be relatively common in COVID-19, regardless of comorbidities. This article is protected by copyright. All rights reserved.