{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:58:37Z","timestamp":1760151517383,"version":"build-2065373602"},"reference-count":54,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2022,3,25]],"date-time":"2022-03-25T00:00:00Z","timestamp":1648166400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Gastrointestinal manifestations may accompany the respiratory symptoms of COVID-19. Abdominal pain (AP) without nausea and vomiting is one of the most common. To date, its role and prognostic value in patients with COVID-19 is still debated. Therefore, we performed a retrospective analysis of 2184 individuals admitted to hospital due to COVID-19. We divided the patients into four groups according to presented symptoms: dyspnea, n = 871 (39.9%); AP, n = 97 (4.4%); AP with dyspnea together, n = 50 (2.3%); and patients without dyspnea and AP, n = 1166 (53.4%). The patients with AP showed tendency to be younger than these with dyspnea, but without AP (63.0 [38.0\u201370.0] vs. 65.0 [52.0\u201374.0] years, p = 0.061), and they were more often females as compared to patients with dyspnea (57.7% vs. 44.6%, p = 0.013, for females). Patients with AP as a separate sign of COVID-19 significantly less often developed pneumonia as compared to individuals with dyspnea or with dyspnea and AP together (p &lt; 0.0001). Patients with AP or AP with dyspnea were significantly less frequently intubated or transferred to the intensive care unit (p = 0.003 and p = 0.031, respectively). Individuals with AP alone or with dyspnea had significantly lower rate of mortality as compared to patients with dyspnea (p = 0.003). AP as a separate symptom and also as a coexisting sign with dyspnea does not predispose the patients with COVID-19 to the worse clinical course and higher mortality.<\/jats:p>","DOI":"10.3390\/jcm11071821","type":"journal-article","created":{"date-parts":[[2022,3,27]],"date-time":"2022-03-27T21:27:51Z","timestamp":1648416471000},"page":"1821","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Assessment of Gastrointestinal Symptoms and Dyspnea in Patients Hospitalized due to COVID-19: Contribution to Clinical Course and Mortality"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3291-5294","authenticated-orcid":false,"given":"Krzysztof","family":"Kaliszewski","sequence":"first","affiliation":[{"name":"Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1377-5601","authenticated-orcid":false,"given":"Dorota","family":"Diakowska","sequence":"additional","affiliation":[{"name":"Department of Basic Science, Faculty of Health Science, Wroclaw Medical University, Bartel Street 5, 51-618 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4273-8196","authenticated-orcid":false,"given":"\u0141ukasz","family":"Nowak","sequence":"additional","affiliation":[{"name":"Department of Urology and Urological Oncology, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4219-7211","authenticated-orcid":false,"given":"Urszula","family":"Tokarczyk","sequence":"additional","affiliation":[{"name":"Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maciej","family":"Sroczy\u0144ski","sequence":"additional","affiliation":[{"name":"Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monika","family":"S\u0119pek","sequence":"additional","affiliation":[{"name":"Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agata","family":"Dudek","sequence":"additional","affiliation":[{"name":"Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karolina","family":"Sutkowska-St\u0119pie\u0144","sequence":"additional","affiliation":[{"name":"Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7352-6992","authenticated-orcid":false,"given":"Katarzyna","family":"Kili\u015b-Pstrusi\u0144ska","sequence":"additional","affiliation":[{"name":"Department of Pediatric Nephrology, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1064-1237","authenticated-orcid":false,"given":"Agnieszka","family":"Matera-Witkiewicz","sequence":"additional","affiliation":[{"name":"Screening Laboratory of Biological Activity Tests and Collection of Biological Material, Faculty of Pharmacy, Wroclaw Medical University, Borowska Street 211A, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Micha\u0142","family":"Pomorski","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcin","family":"Protasiewicz","sequence":"additional","affiliation":[{"name":"Department and Clinic of Cardiology, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janusz","family":"Soko\u0142owski","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0541-841X","authenticated-orcid":false,"given":"Barbara","family":"Adamik","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2812-4702","authenticated-orcid":false,"given":"Krzysztof","family":"Kujawa","sequence":"additional","affiliation":[{"name":"Statistical Analysis Center, Wroclaw Medical University, Marcinkowski Street 2-6, 50-368 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5472-028X","authenticated-orcid":false,"given":"Adrian","family":"Doroszko","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katarzyna","family":"Madziarska","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ewa Anita","family":"Jankowska","sequence":"additional","affiliation":[{"name":"Centre for Heart Diseases, Department of Heart Diseases, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"4143","DOI":"10.3748\/wjg.v27.i26.4143","article-title":"Abdominal and gastrointestinal manifestations in COVID-19 patients: Is imaging useful?","volume":"27","author":"Boraschi","year":"2021","journal-title":"World J. Gastroenterol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"552","DOI":"10.3174\/ajnr.A6526","article-title":"Novel coronavirus: What neuroradiologists as citizens of the world need to know","volume":"41","author":"Mahajan","year":"2020","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_3","unstructured":"World Health Organization (2020, March 11). WHO Director-General\u2019s Opening Remarks at the Media Briefing on COVID-19. Available online: https:\/\/www.who.int\/dg\/speeches\/detail\/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"112158","DOI":"10.1016\/j.biopha.2021.112158","article-title":"A mini-review on the impact of COVID 19 on vital organs","volume":"143","author":"Shah","year":"2021","journal-title":"Biomed. Pharmacother."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1610","DOI":"10.1080\/14767058.2020.1759542","article-title":"COVID-19 in neonates","volume":"35","author":"Kallem","year":"2020","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1016\/S2468-1253(20)30057-1","article-title":"Liver injury in COVID-19: Management and challenges","volume":"5","author":"Zhang","year":"2020","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1016\/j.cell.2020.09.016","article-title":"The immunology of multisystem inflammatory syndrome in children with COVID-19","volume":"183","author":"Consiglio","year":"2020","journal-title":"Cell"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.cell.2020.02.052","article-title":"SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor","volume":"181","author":"Hoffmann","year":"2020","journal-title":"Cell"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e13168","DOI":"10.1111\/acel.13168","article-title":"Individual variation of the SARS-CoV-2 receptor ACE2 gene expression and regulation","volume":"19","author":"Chen","year":"2020","journal-title":"Aging Cell"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1016\/S0140-6736(20)30937-5","article-title":"Endothelial cell infection and endotheliitis in COVID-19","volume":"395","author":"Varga","year":"2020","journal-title":"Lancet"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1002\/path.1570","article-title":"Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis","volume":"203","author":"Hamming","year":"2004","journal-title":"J. Pathol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"227","DOI":"10.4329\/wjr.v13.i7.227","article-title":"Abdominal imaging in COVID-19","volume":"13","author":"Balaban","year":"2021","journal-title":"World J. Radiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1056\/NEJMoa2001191","article-title":"First case of 2019 novel coronavirus in the United States","volume":"382","author":"Holshue","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1636","DOI":"10.1016\/j.cgh.2020.03.043","article-title":"Don\u2019t overlook digestive symptoms in patients with 2019 novel coronavirus disease (COVID-19)","volume":"18","author":"Luo","year":"2020","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1056\/NEJMoa2002032","article-title":"Clinical characteristics of coronavirus disease 2019 in China","volume":"382","author":"Guan","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"607","DOI":"10.2214\/AJR.20.23232","article-title":"Lung base findings of coronavirus disease (COVID-19) on abdominal CT in patients with predominant gastrointestinal symptoms","volume":"215","author":"Siegel","year":"2020","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"916","DOI":"10.14309\/ajg.0000000000000664","article-title":"Digestive symptoms in COVID-19 patients with mild disease severity: Clinical presentation, stool viral RNA testing, and outcomes","volume":"115","author":"Han","year":"2020","journal-title":"Am. J. Gastroenterol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1632","DOI":"10.1016\/j.mayocp.2020.06.003","article-title":"Prevalence and mortality of COVID-19 patients with gastrointestinal symptoms: A systematic review and meta-analysis","volume":"95","author":"Tariq","year":"2020","journal-title":"Mayo Clin. Proc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1053\/j.gastro.2020.03.065","article-title":"Gastrointestinal manifestations of SARS-CoV-2 infection and virus load in fecal samples from a Hong Kong cohort: Systematic review and meta-analysis","volume":"159","author":"Cheung","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"348","DOI":"10.13105\/wjma.v8.i5.348","article-title":"Gastrointestinal and hepatic manifestations of COVID-19 infection: Lessons for practitioners","volume":"8","author":"Pasha","year":"2020","journal-title":"World J. Meta Anal."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1053\/j.gastro.2020.05.001","article-title":"AGA institute rapid review of the gastrointestinal and liver manifestations of COVID-19, meta-analysis of international data, and recommendations for the consultative management of patients with COVID-19","volume":"159","author":"Sultan","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1871","DOI":"10.1053\/j.gastro.2020.04.044","article-title":"Increased amylase and lipase in patients with COVID-19 pneumonia: Don\u2019t blame the pancreas just yet!","volume":"160","author":"Siau","year":"2021","journal-title":"Gastroenterology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1038\/s41575-020-00389-y","article-title":"COVID-19 and acute pancreatitis: Examining the causality","volume":"18","author":"Capurso","year":"2021","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1016\/j.pan.2020.05.003","article-title":"COVID-19 presenting as acute pancreatitis","volume":"20","author":"Aloysius","year":"2020","journal-title":"Pancreatology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1286","DOI":"10.14309\/ajg.0000000000000732","article-title":"Lipase elevation in patients with COVID-19","volume":"115","author":"Jin","year":"2020","journal-title":"Am. J. Gastroenterol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1551","DOI":"10.1053\/j.gastro.2020.05.069","article-title":"Emerging phenotype of severe acute respiratory syndrome-Coronavirus 2-associated pancreatitis","volume":"159","author":"Szatmary","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"6270","DOI":"10.3748\/wjg.v26.i40.6270","article-title":"Insufficient etiological workup of COVID-19-associated acute pancreatitis: A systematic review","volume":"26","author":"Ocskay","year":"2020","journal-title":"World J. Gastroenterol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2403","DOI":"10.2147\/JPR.S313978","article-title":"COVID-pain: Acute and late-onset painful clinical manifestations in COVID-19-molecular mechanisms and research perspectives","volume":"14","author":"Cascella","year":"2021","journal-title":"J. Pain Res."},{"key":"ref_29","first-page":"e13901","article-title":"An unusual case of gastrointestinal bleeding in a patient with COVID-19","volume":"13","author":"Sanku","year":"2021","journal-title":"Cureus"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1866","DOI":"10.1148\/rg.2020200195","article-title":"Multisystem imaging manifestations of COVID-19, part 2: From cardiac complications to pediatric manifestations","volume":"40","author":"Revzin","year":"2020","journal-title":"Radiographics"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"E207","DOI":"10.1148\/radiol.2020201908","article-title":"Abdominal imaging findings in COVID-19: Preliminary observations","volume":"297","author":"Bhayana","year":"2020","journal-title":"Radiology"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1002\/jmv.26134","article-title":"Pancreatic injury in the course of coronavirus disease 2019: A not-so-rare occurrence","volume":"93","author":"Bruno","year":"2021","journal-title":"J. Med. Virol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1002\/cld.967","article-title":"Interrelationship between coronavirus infection and liver disease","volume":"15","author":"Schaefer","year":"2020","journal-title":"Clin. Liver Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1161\/CIRCULATIONAHA.120.047549","article-title":"The science underlying COVID-19: Implications for the cardiovascular system","volume":"142","author":"Liu","year":"2020","journal-title":"Circulation"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"101825","DOI":"10.1016\/j.tmaid.2020.101825","article-title":"Comorbidities, clinical signs and symptoms, laboratory findings, imaging features, treatment strategies, and outcomes in adult and pediatric patients with COVID-19: A systematic review and meta-analysis","volume":"37","author":"Jutzeler","year":"2020","journal-title":"Travel Med. Infect. Dis."},{"key":"ref_36","first-page":"20","article-title":"Viral loads in clinical specimens and SARS manifestations","volume":"15","author":"Hung","year":"2009","journal-title":"Hong Kong Med. J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1543","DOI":"10.1136\/gutjnl-2020-321388","article-title":"Faecal calprotectin indicates intestinal inflammation in COVID-19","volume":"69","author":"Effenberger","year":"2020","journal-title":"Gut"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2613","DOI":"10.1007\/s00261-020-02669-2","article-title":"Abdominopelvic CT findings in patients with novel coronavirus disease 2019 (COVID-19)","volume":"45","author":"Fink","year":"2020","journal-title":"Abdom. Radiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/j.pop.2018.04.001","article-title":"Guidelines for the evaluation and treatment of pneumonia","volume":"45","author":"Grief","year":"2018","journal-title":"Prim. Care"},{"key":"ref_40","first-page":"192","article-title":"Could flank pain be an indicator of COVID-19 infection?","volume":"32","author":"Durmus","year":"2020","journal-title":"Malawi Med. J."},{"key":"ref_41","first-page":"71","article-title":"Enteral feeding and its impact on the gut immune system and intestinal mucosal barrier","volume":"10","author":"Szefel","year":"2015","journal-title":"Prz. Gastroenterol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"766","DOI":"10.14309\/ajg.0000000000000620","article-title":"Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: A descriptive, cross-sectional, multicenter study","volume":"115","author":"Pan","year":"2020","journal-title":"Am. J. Gastroenterol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1097\/JCMA.0000000000000319","article-title":"Gastrointestinal and liver manifestations in patients with COVID-19","volume":"83","author":"Lee","year":"2020","journal-title":"J. Chin. Med. Assoc."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1111\/liv.14435","article-title":"Liver injury during highly pathogenic human coronavirus infections","volume":"40","author":"Xu","year":"2020","journal-title":"Liver Int."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"105951","DOI":"10.1016\/j.ijantimicag.2020.105951","article-title":"Coronavirus disease 2019 (COVID-19): Current status and future perspectives","volume":"55","author":"Li","year":"2020","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1007\/s13238-020-00718-6","article-title":"Recapitulation of SARS-CoV-2 infection and cholangiocyte damage with human liver ductal organoids","volume":"11","author":"Zhao","year":"2020","journal-title":"Protein Cell"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1111\/liv.14730","article-title":"Pathophysiological mechanisms of liver injury in COVID-19","volume":"41","author":"Nardo","year":"2021","journal-title":"Liver Int."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1016\/j.jhep.2020.04.006","article-title":"COVID-19: Abnormal liver function tests","volume":"73","author":"Cai","year":"2020","journal-title":"J. Hepatol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1053\/j.gastro.2020.04.064","article-title":"Clinical characteristics and outcomes of coronavirus disease 2019 among patients with preexisting liver disease in the United States: A multicenter research network study","volume":"159","author":"Singh","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2128","DOI":"10.1016\/j.cgh.2020.04.040","article-title":"ACE2 expression in pancreas may cause pancreatic damage after SARS-CoV-2 infection","volume":"18","author":"Liu","year":"2020","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1053\/j.gastro.2020.03.055","article-title":"Pancreatic injury patterns in patients with coronavirus disease 19 pneumonia","volume":"159","author":"Wang","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_52","first-page":"576","article-title":"Pathological changes of the spleen in ten patients with coronavirus disease 2019 (COVID-19) by postmortem needle autopsy","volume":"49","author":"Xu","year":"2020","journal-title":"Zhonghua Bing Li Xue Za Zhi"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1097\/QCO.0000000000000760","article-title":"Gastrointestinal manifestations of coronavirus disease 2019","volume":"34","author":"Joshi","year":"2021","journal-title":"Curr. Opin. Infect. Dis."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.ijid.2021.09.013","article-title":"Coronavirus disease-19 and the gut-lung axis","volume":"113","author":"Zhou","year":"2021","journal-title":"Int. J. Infect. Dis."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/7\/1821\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:43:09Z","timestamp":1760136189000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/7\/1821"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,25]]},"references-count":54,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["jcm11071821"],"URL":"https:\/\/doi.org\/10.3390\/jcm11071821","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2022,3,25]]}}}