{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T16:30:57Z","timestamp":1777134657909,"version":"3.51.4"},"reference-count":56,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,11,21]],"date-time":"2020-11-21T00:00:00Z","timestamp":1605916800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["JGH Open"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Aim<\/jats:title><jats:p>This review investigates the role of gastrointestinal and hepatic manifestations in COVID\u201019, particularly with regard to the prevalence of isolated gastrointestinal (GI) symptoms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We searched PubMed, Embase, and Cochrane library for COVID\u201019 publications from 1 December 2019 to 18 May 2020. We included any study that reported the presence of GI symptoms in a sample of &gt;5 COVID\u201019 patients. Data collection and risk of bias assessment were performed independently by two reviewers. Where \u22653 studies reported data sufficiently similar to allow calculation of a pooled prevalence, we performed random effects meta\u2010analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>This review included 17\u2009776 COVID\u201019 patients from 108 studies. Isolated GI symptoms only occurred in 1% (95% confidence interval [CI] 0\u20136%) of patients. GI symptoms were reported in 20% (95% CI 15\u201324%) of patients. The most common were anorexia (21%, 95% CI 15\u201327%), diarrhea (13%, 95% CI 11\u201316%), nausea or vomiting (8%, 95% CI 6\u201311%), and abdominal pain (4%, 95% CI 2\u20136%). Transaminase elevations were present in 24% (95% CI 17\u201331%) of patients. Higher prevalence of GI symptoms were reported in studies published after 1st April, with prevalence of diarrhea 16% (95% CI 13\u201320), nausea or vomiting 12% (95% CI 8\u201316%), and any GI symptoms 24% (95% CI 18\u201334%). GI symptoms were associated with severe COVID\u201019 disease (odds ratio [OR] 2.1, 95% CI 1.3\u20133.2), but not mortality (OR 0.90, 95% CI 0.52\u20131.54).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Patients with isolated GI symptoms may represent a small but significant portion of COVID\u201019 cases. When testing resources are abundant, clinicians should still consider testing patients with isolated GI symptoms or unexplained transaminase elevations for COVID\u201019. More recent studies estimate higher overall GI involvement in COVID\u201019 than was previously recognized.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jgh3.12456","type":"journal-article","created":{"date-parts":[[2020,11,21]],"date-time":"2020-11-21T13:11:06Z","timestamp":1605964266000},"page":"107-115","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Gastrointestinal and hepatic manifestations of <scp>COVID<\/scp>\u201019: A systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0796-9300","authenticated-orcid":false,"given":"Robert D","family":"Dorrell","sequence":"first","affiliation":[{"name":"Department of Medicine Medical Center Blvd  Winston\u2010Salem North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael K","family":"Dougherty","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric L","family":"Barash","sequence":"additional","affiliation":[{"name":"Department of Wake Forest School of Medicine Medical Center Blvd  Winston\u2010Salem North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6190-8934","authenticated-orcid":false,"given":"Asher E","family":"Lichtig","sequence":"additional","affiliation":[{"name":"Department of Wake Forest School of Medicine Medical Center Blvd  Winston\u2010Salem North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven B","family":"Clayton","sequence":"additional","affiliation":[{"name":"Department of Medicine, Section on Gastroenterology Medical Center Blvd  Winston\u2010Salem North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth T","family":"Jensen","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Prevention Medical Center Blvd  Winston\u2010Salem North Carolina USA"},{"name":"Department of Medicine, Section on Gastroenterology Medical Center Blvd  Winston\u2010Salem North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,11,21]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"CDC.Coronavirus Disease (COVID\u201019) Centers for Disease Control and Prevention: US Department of Health and Human Services 2020. 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