A considerable rate of COVID-19 GI symptoms is associated with antimicrobial therapy: Findings from a large western prospective cohort

Background: Gastrointestinal symptoms are commonly described in patients with COVID-19, but most reports are retrospective and come from Eastern countries Objective: Our aim was to evaluate prospectively gastrointestinal symptoms in Western patients with COVID-19 Methods: We assessed gastrointestinal symptoms in all inpatients with COVID-19 at our hospital, through the Gastrointestinal Symptoms Rating Scale (GSRS), both at admission and after the start of therapy Univariate and multivariate analysis for critical clinical picture and death were obtained Results: Of 420 enrolled patients, 247 patients (59%) reported at least one gastrointestinal symptom, of which the most common were diarrhoea (37%), nausea (19%), urgency (17%), loose stools (16%) and Upper gastrointestinal pain (14%) One-hundred- and- seventeen patients (47%) were symptomatic at admission, while 130 patients (53%) developed symptoms only after the start of COVID-19 therapy Upper gastrointestinal symptoms, including heartburn (15/117 vs 4/130, P = 0 007), acid reflux (15/117 vs 6/130, P = 0 02), hunger pains (10/117 vs 1/130, P = 0 003), nausea (43/117 vs 35/130, P = 0 04), and rumbling (11/117 vs 3/130, P = 0 02), were more frequent at admission, while diarrhoea appeared more commonly after antimicrobial therapy (57/117 vs 98/130, P < 0 0001) Gastrointestinal symptoms (OR 2 35, P = 0 04) independently predicted critical clinical picture Conclusion: In our cohort the majority of patients with COVID-19 presented with gastrointestinal symptoms, which had two separate patterns according to the timing of their appearance (at admission vs after antimicrobial therapy) and predicted a worse clinical picture Our results may be useful to disentangle characteristics and relevance of the gastrointestinal involvement in patients with COVID-19