COVID-19-associated nausea and vomiting: Difference between revisions

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==Overview==
==Overview==
SARS-CoV-2 mainly causes severe acute respiratory syndrome but may also present with gastrointestinal symptoms like diarrhea. It invades through the Angiotensin-converting enzyme 2 (ACE2) and the serine protease TMPRSS2 receptors present abundantly not only in the lungs but also in the enterocytes of the small intestine. Nausea and vomiting are the less common gastrointestinal symptoms seen. Anorexia and diarrhea are more common.
[[SARS-CoV-2]] mainly causes severe acute [[Respiratory system|respiratory]] syndrome but may also present with gastrointestinal symptoms like diarrhea. It invades through the [[Angiotensin-converting enzyme 2]] (ACE2) and the serine protease [[TMPRSS2]] receptors present abundantly not only in the [[Lung|lungs]] but also in the [[Enterocyte|enterocytes]] of the [[small intestine]]. [[Nausea and vomiting|Nausea]] and [[Nausea and vomiting|vomiting]] are the less common gastrointestinal symptoms seen. [[Anorexia]] and [[diarrhea]] are more common.


==Historical Perspective==
==Historical Perspective==
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*Entry of the virus causes disruption of the [[Enterocyte|enterocytes]] and may lead to inflammation and alteration of [[Intestine|intestinal]] [[permeability]].
*Entry of the virus causes disruption of the [[Enterocyte|enterocytes]] and may lead to inflammation and alteration of [[Intestine|intestinal]] [[permeability]].
* The gastrointestinal symptoms of COVID-19 are thought to arise due to the invasion of enterocytes. <ref name="pmid32376697">{{cite journal| author=Wahba L, Jain N, Fire AZ, Shoura MJ, Artiles KL, McCoy MJ | display-authors=etal| title=An Extensive Meta-Metagenomic Search Identifies SARS-CoV-2-Homologous Sequences in Pangolin Lung Viromes. | journal=mSphere | year= 2020 | volume= 5 | issue= 3 | pages=  | pmid=32376697 | doi=10.1128/mSphere.00160-20 | pmc=7203451 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32376697  }} </ref>
* The gastrointestinal symptoms of COVID-19 are thought to arise due to the invasion of enterocytes. <ref name="pmid32376697">{{cite journal| author=Wahba L, Jain N, Fire AZ, Shoura MJ, Artiles KL, McCoy MJ | display-authors=etal| title=An Extensive Meta-Metagenomic Search Identifies SARS-CoV-2-Homologous Sequences in Pangolin Lung Viromes. | journal=mSphere | year= 2020 | volume= 5 | issue= 3 | pages=  | pmid=32376697 | doi=10.1128/mSphere.00160-20 | pmc=7203451 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32376697  }} </ref>
==Differentiating ((Page name)) from other Diseases==
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
OR
[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].


==Epidemiology and Demographics==
==Epidemiology and Demographics==
*According to a study by Redd et al, the prevalence of nausea in COVID-19 patients was 26%. <ref name="pmid32333911">{{cite journal| author=Redd WD, Zhou JC, Hathorn KE, McCarty TR, Bazarbashi AN, Thompson CC | display-authors=etal| title=Prevalence and Characteristics of Gastrointestinal Symptoms in Patients with SARS-CoV-2 Infection in the United States: A Multicenter Cohort Study. | journal=Gastroenterology | year= 2020 | volume=  | issue=  | pages=  | pmid=32333911 | doi=10.1053/j.gastro.2020.04.045 | pmc=7195377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32333911  }} </ref>
*According to a study by Redd et al, the prevalence of nausea in COVID-19 patients was 26%. <ref name="pmid32333911">{{cite journal| author=Redd WD, Zhou JC, Hathorn KE, McCarty TR, Bazarbashi AN, Thompson CC | display-authors=etal| title=Prevalence and Characteristics of Gastrointestinal Symptoms in Patients with SARS-CoV-2 Infection in the United States: A Multicenter Cohort Study. | journal=Gastroenterology | year= 2020 | volume=  | issue=  | pages=  | pmid=32333911 | doi=10.1053/j.gastro.2020.04.045 | pmc=7195377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32333911  }} </ref>
The more common GI symptoms were-
The more common GI symptoms were-
*Anorexia- 35 %
*[[Anorexia]]- 35 %
*Diarrhea- 34 %  
*[[Diarrhea]]- 34 %


* Another study by Luo et al reported that 16% of patients presented with GI symptoms like diarrhea, nausea, vomiting without any respiratory symptoms. <ref name="pmid32205220">{{cite journal| author=Luo S, Zhang X, Xu H| title=Don't Overlook Digestive Symptoms in Patients With 2019 Novel Coronavirus Disease (COVID-19). | journal=Clin Gastroenterol Hepatol | year= 2020 | volume= 18 | issue= 7 | pages= 1636-1637 | pmid=32205220 | doi=10.1016/j.cgh.2020.03.043 | pmc=7154217 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32205220  }} </ref>
* Another study by Luo et al reported that 16% of patients presented with GI symptoms like [[diarrhea]], [[Nausea and vomiting|nausea]], [[vomiting]] without any respiratory symptoms. <ref name="pmid32205220">{{cite journal| author=Luo S, Zhang X, Xu H| title=Don't Overlook Digestive Symptoms in Patients With 2019 Novel Coronavirus Disease (COVID-19). | journal=Clin Gastroenterol Hepatol | year= 2020 | volume= 18 | issue= 7 | pages= 1636-1637 | pmid=32205220 | doi=10.1016/j.cgh.2020.03.043 | pmc=7154217 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32205220  }} </ref>


==Risk Factors==
==Risk Factors==
Some gastrointestinal factors may predispose patients to infection with COVID-19.
Some gastrointestinal factors may predispose patients to infection with COVID-19.
*[[Inflammatory bowel disease]] patients- due to use to [[glucocorticoids]], but not [[TNF-alpha|TNF-alpha inhibitors]] <ref name="pmid32425234">{{cite journal| author=Brenner EJ, Ungaro RC, Gearry RB, Kaplan GG, Kissous-Hunt M, Lewis JD | display-authors=etal| title=Corticosteroids, but not TNF Antagonists, are Associated with Adverse COVID-19 Outcomes in Patients With Inflammatory Bowel Diseases: Results from an International Registry. | journal=Gastroenterology | year= 2020 | volume=  | issue=  | pages=  | pmid=32425234 | doi=10.1053/j.gastro.2020.05.032 | pmc=7233252 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32425234  }} </ref>
*[[Inflammatory bowel disease]] patients- due to use to [[glucocorticoids]], but not [[TNF-alpha|TNF-alpha inhibitors]] <ref name="pmid32425234">{{cite journal| author=Brenner EJ, Ungaro RC, Gearry RB, Kaplan GG, Kissous-Hunt M, Lewis JD | display-authors=etal| title=Corticosteroids, but not TNF Antagonists, are Associated with Adverse COVID-19 Outcomes in Patients With Inflammatory Bowel Diseases: Results from an International Registry. | journal=Gastroenterology | year= 2020 | volume=  | issue=  | pages=  | pmid=32425234 | doi=10.1053/j.gastro.2020.05.032 | pmc=7233252 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32425234  }} </ref>
* Increasing age
* Increasing [[age]]
* Other [[Comorbidity|comorbidities]]
* Other [[Comorbidity|comorbidities]]
* Use of [[glucocorticoids]]
* Use of [[glucocorticoids]]


==Screening==
==Screening==
There is insufficient evidence to recommend routine screening.
There is insufficient evidence to recommend routine [[Screening (medicine)|screening]].
 
==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
 
OR
 
Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
 
OR
 
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.


==Diagnosis==
==Diagnosis==
===Diagnostic Study of Choice===
===Diagnostic Study of Choice===
* COVID-19 nausea and vomiting can be diagnosed based on the history of the same and other gastrointestinal symptoms like anorexia, diarrhea and a positive [[Human feces|stool]] test for SARS-CoV-2
*[[COVID-19]] [[nausea and vomiting]] can be diagnosed based on the history of the same and other gastrointestinal symptoms like [[anorexia]], [[diarrhea]] and a positive [[Human feces|stool]] test for [[SARS-CoV-2]]
* There are no established criteria for the diagnosis of nausea and vomiting in COVID-19.
* There are no established [[Criterion|criteria]] for the diagnosis of [[nausea and vomiting]] in [[COVID-19]].


===History and Symptoms===
===History and Symptoms===
*According to a study by Redd et al, the prevalence of nausea in COVID-19 patients was 26%. <ref name="pmid32333911">{{cite journal| author=Redd WD, Zhou JC, Hathorn KE, McCarty TR, Bazarbashi AN, Thompson CC | display-authors=etal| title=Prevalence and Characteristics of Gastrointestinal Symptoms in Patients with SARS-CoV-2 Infection in the United States: A Multicenter Cohort Study. | journal=Gastroenterology | year= 2020 | volume=  | issue=  | pages=  | pmid=32333911 | doi=10.1053/j.gastro.2020.04.045 | pmc=7195377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32333911  }} </ref>
*According to a study by Redd et al, the prevalence of [[nausea]] in [[COVID-19]] patients was 26%. <ref name="pmid32333911">{{cite journal| author=Redd WD, Zhou JC, Hathorn KE, McCarty TR, Bazarbashi AN, Thompson CC | display-authors=etal| title=Prevalence and Characteristics of Gastrointestinal Symptoms in Patients with SARS-CoV-2 Infection in the United States: A Multicenter Cohort Study. | journal=Gastroenterology | year= 2020 | volume=  | issue=  | pages=  | pmid=32333911 | doi=10.1053/j.gastro.2020.04.045 | pmc=7195377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32333911  }} </ref>
The more common GI symptoms were-
The more common GI symptoms were-
*Anorexia- 35 %
*[[Anorexia]]- 35 %
*Diarrhea- 34 %  
*[[Diarrhea]]- 34 %
 
* Another study by Luo et al reported that 16% of patients presented with GI symptoms like diarrhea, nausea, vomiting without any respiratory symptoms. <ref name="pmid32205220">{{cite journal| author=Luo S, Zhang X, Xu H| title=Don't Overlook Digestive Symptoms in Patients With 2019 Novel Coronavirus Disease (COVID-19). | journal=Clin Gastroenterol Hepatol | year= 2020 | volume= 18 | issue= 7 | pages= 1636-1637 | pmid=32205220 | doi=10.1016/j.cgh.2020.03.043 | pmc=7154217 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32205220  }} </ref>
 
===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
 
OR
 
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR


The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
* Another study by Luo et al reported that 16% of patients presented with GI symptoms like [[diarrhea]], [[Nausea and vomiting|nausea]], [[vomiting]] without any respiratory symptoms. <ref name="pmid32205220">{{cite journal| author=Luo S, Zhang X, Xu H| title=Don't Overlook Digestive Symptoms in Patients With 2019 Novel Coronavirus Disease (COVID-19). | journal=Clin Gastroenterol Hepatol | year= 2020 | volume= 18 | issue= 7 | pages= 1636-1637 | pmid=32205220 | doi=10.1016/j.cgh.2020.03.043 | pmc=7154217 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32205220  }} </ref>


===Laboratory Findings===
===Laboratory Findings===
* Infectious [[virions]] released from the GI tract can be monitored by real-time [[Reverse transcription polymerase chain reaction|reverse transcriptase polymerase chain reaction]] (rRT-PCR)
* Infectious [[virions]] released from the [[Gastrointestinal tract|GI tract]] can be monitored by real-time [[Reverse transcription polymerase chain reaction|reverse transcriptase polymerase chain reaction]] (rRT-PCR)
* A study by Xiao et al assessed the clinical significance of measuring [[SARS-CoV-2]] RNA in the feces. <ref name="pmid32142773">{{cite journal| author=Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H| title=Evidence for Gastrointestinal Infection of SARS-CoV-2. | journal=Gastroenterology | year= 2020 | volume= 158 | issue= 6 | pages= 1831-1833.e3 | pmid=32142773 | doi=10.1053/j.gastro.2020.02.055 | pmc=7130181 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32142773  }} </ref>
* A study by Xiao et al assessed the [[clinical]] significance of measuring [[SARS-CoV-2]] RNA in the feces. <ref name="pmid32142773">{{cite journal| author=Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H| title=Evidence for Gastrointestinal Infection of SARS-CoV-2. | journal=Gastroenterology | year= 2020 | volume= 158 | issue= 6 | pages= 1831-1833.e3 | pmid=32142773 | doi=10.1053/j.gastro.2020.02.055 | pmc=7130181 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32142773  }} </ref>
* The fecal test remained positive until 12 days after the disease onset in patients with diarrhea.
* The [[Feces|fecal]] test remained positive until 12 days after the disease onset in patients with [[diarrhea]].
* Notably, stool test for [[RNA|viral RNA]] remained positive despite negative respiratory tests. This suggests the possibility of gastrointestinal transmission via the fecal-oral route despite clearance from the respiratory tract.
* Notably, stool test for [[RNA|viral RNA]] remained positive despite negative [[Respiratory system|respiratory]] tests. This suggests the possibility of gastrointestinal transmission via the [[fecal-oral route]] despite clearance from the respiratory tract.
* It was recommended [[Transmission (medicine)|transmission]]-based precautions for hospitalized COVID-19 patients should be continued till the rRT-PCR for SARS-CoV-2 turns negative.
* It was recommended [[Transmission (medicine)|transmission]]-based precautions for hospitalized [[COVID-19]] patients should be continued till the rRT-[[Polymerase chain reaction|PCR]] for [[SARS-CoV-2]] turns negative.


===Electrocardiogram===
===Electrocardiogram===
There are no ECG findings associated with nausea and vomiting in COVID-19.
There are no [[The electrocardiogram|ECG]] findings associated with nausea and vomiting in COVID-19.


===X-ray===
===X-ray===
*The [[Chest X-ray|chest x ray]] findings in a suspected case of coronavirus [[infection]] can mimic the findings in [[pneumonia]], which can include:
*The [[Chest X-ray|chest x ray]] findings in a suspected case of [[coronavirus]] [[infection]] can mimic the findings in [[pneumonia]], which can include:


:*[[Consolidation (medicine)|Consolidation]]<ref name="pmid31986264">{{cite journal |vauthors=Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J, Cao B |title=Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China |journal=Lancet |volume= |issue= |pages= |date=January 2020 |pmid=31986264 |doi=10.1016/S0140-6736(20)30183-5 |url=}}</ref>
:*[[Consolidation (medicine)|Consolidation]]<ref name="pmid31986264">{{cite journal |vauthors=Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J, Cao B |title=Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China |journal=Lancet |volume= |issue= |pages= |date=January 2020 |pmid=31986264 |doi=10.1016/S0140-6736(20)30183-5 |url=}}</ref>
Line 107: Line 74:


===Echocardiography or Ultrasound===
===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with nausea and vomiting in COVID-19.
There are no [[echocardiography]]/[[ultrasound]] findings associated with nausea and vomiting in COVID-19.


===CT scan===
===CT scan===
There are no CT scan findings associated with nausea and vomiting in COVID-19.
There are no [[Computed tomography|CT scan]] findings associated with nausea and vomiting in COVID-19.


===MRI===
===MRI===
There are no MRI findings associated with nausea and vomiting in COVID-19.
There are no [[Magnetic resonance imaging|MRI]] findings associated with nausea and vomiting in COVID-19.


===Other Imaging Findings===
===Other Imaging Findings===
Line 124: Line 91:
===Medical Therapy===
===Medical Therapy===


* Supportive management is the mainstay of treatment of nausea and vomiting.
* Supportive management is the mainstay of treatment of [[nausea and vomiting]].
* Antiemetic drugs are used for symptomatic relief. 5-HT3 antagonists like ondansetron, granisetron, dolasetron, and palonosetron are commonly used.
*[[Antiemetic|Antiemetic drugs]] are used for [[symptomatic]] relief. [[5-HT3 antagonist|5-HT3 antagonists]] like [[ondansetron]], [[granisetron]], [[dolasetron]], and [[palonosetron]] are commonly used.
* Rehydration, fluid repletion, and potassium monitoring are essential.
*[[Rehydration]], [[Fluid|fluid repletion]], and [[potassium]] monitoring are essential.


===Primary Prevention===
===Primary Prevention===


There are no available [[Vaccine|vaccines]] against COVID-19 as of now, but several vaccines are under development and in trials. Standard measures for respiratory viruses are recommended-  
There are no available [[Vaccine|vaccines]] against [[COVID-19]] as of now, but several [[Vaccine|vaccines]] are under development and in trials. Standard measures for [[Respiratory system|respiratory]] [[Virus|viruses]] are recommended-  
* Use of face masks
* Use of face masks
* Frequent hand hygiene (alcohol-based [[Disinfectant|disinfectants]] or soap and water),
* Frequent hand hygiene (alcohol-based [[Disinfectant|disinfectants]] or soap and water),
* Travel restrictions
* Travel restrictions
* Social distancing measures
* Social distancing measures
* Avoiding contact with infected patients
* Avoiding contact with [[infected]] patients


===Prevention of transmission through gastrointenstinal tract===
===Prevention of transmission through gastrointenstinal tract===
* Presence of the virus in the stool raises suspicion for [[fecal-oral route|fecal-oral transmission]] of SARS-CoV-2
* Presence of the virus in the stool raises suspicion for [[fecal-oral route|fecal-oral transmission]] of [[SARS-CoV-2]]
* Appropriate personal protective equipment(PPE) must be used while handling sources of contamination like feces.
* Appropriate personal protective equipment(PPE) must be used while handling sources of contamination like [[feces]].
*[[Elective]] appointments and [[Endoscopy|endoscopies]] should be rescheduled and extreme care must be taken by health care professionals of the endoscopy units to avoid spreading the virus from one patient to another. <ref name="pmid32197957">{{cite journal| author=Ungaro RC, Sullivan T, Colombel JF, Patel G| title=What Should Gastroenterologists and Patients Know About COVID-19? | journal=Clin Gastroenterol Hepatol | year= 2020 | volume= 18 | issue= 7 | pages= 1409-1411 | pmid=32197957 | doi=10.1016/j.cgh.2020.03.020 | pmc=7156804 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32197957  }} </ref>
*[[Elective]] appointments and [[Endoscopy|endoscopies]] should be rescheduled and extreme care must be taken by health care professionals of the [[endoscopy]] units to avoid spreading the virus from one patient to another. <ref name="pmid32197957">{{cite journal| author=Ungaro RC, Sullivan T, Colombel JF, Patel G| title=What Should Gastroenterologists and Patients Know About COVID-19? | journal=Clin Gastroenterol Hepatol | year= 2020 | volume= 18 | issue= 7 | pages= 1409-1411 | pmid=32197957 | doi=10.1016/j.cgh.2020.03.020 | pmc=7156804 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32197957  }} </ref>
* Patients listed for fecal [[Microbiome|microbiota]] transplantation and donors should be screened for the SARS-CoV-2.
* Patients listed for fecal [[Microbiome|microbiota]] transplantation and [[Donor|donors]] should be screened for the [[SARS-CoV-2]].


==References==
==References==

Revision as of 17:04, 8 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ifrah Fatima, M.B.B.S[2]

Synonyms and keywords:

Overview

SARS-CoV-2 mainly causes severe acute respiratory syndrome but may also present with gastrointestinal symptoms like diarrhea. It invades through the Angiotensin-converting enzyme 2 (ACE2) and the serine protease TMPRSS2 receptors present abundantly not only in the lungs but also in the enterocytes of the small intestine. Nausea and vomiting are the less common gastrointestinal symptoms seen. Anorexia and diarrhea are more common.

Historical Perspective

  • The etiological agent is SARS-CoV-2, named for the similarity of its symptoms to those induced by the severe acute respiratory syndrome, causing coronavirus disease 2019 (COVID-19), is a virus identified as the cause of an outbreak of respiratory illness first detected in Wuhan, China.[1][2]
  • The growing number of patients however, suggest that human-to-human transmission is actively occurring.[3][4]
  • The outbreak was declared a Public Health Emergency of International Concern on 30 January 2020.
  • On March 12, 2020, the World Health Organization declared the COVID-19 outbreak a pandemic.

Classification

There is no established system for the classification of nausea and vomiting in COVID-19.

Pathophysiology

Epidemiology and Demographics

  • According to a study by Redd et al, the prevalence of nausea in COVID-19 patients was 26%. [8]

The more common GI symptoms were-

  • Another study by Luo et al reported that 16% of patients presented with GI symptoms like diarrhea, nausea, vomiting without any respiratory symptoms. [9]

Risk Factors

Some gastrointestinal factors may predispose patients to infection with COVID-19.

Screening

There is insufficient evidence to recommend routine screening.

Diagnosis

Diagnostic Study of Choice

History and Symptoms

  • According to a study by Redd et al, the prevalence of nausea in COVID-19 patients was 26%. [8]

The more common GI symptoms were-

  • Another study by Luo et al reported that 16% of patients presented with GI symptoms like diarrhea, nausea, vomiting without any respiratory symptoms. [9]

Laboratory Findings

Electrocardiogram

There are no ECG findings associated with nausea and vomiting in COVID-19.

X-ray

Echocardiography or Ultrasound

There are no echocardiography/ultrasound findings associated with nausea and vomiting in COVID-19.

CT scan

There are no CT scan findings associated with nausea and vomiting in COVID-19.

MRI

There are no MRI findings associated with nausea and vomiting in COVID-19.

Other Imaging Findings

There are no other imaging findings associated with nausea and vomiting in COVID-19.

Other Diagnostic Studies

There are no other diagnostic studies associated with nausea and vomiting in COVID-19.

Treatment

Medical Therapy

Primary Prevention

There are no available vaccines against COVID-19 as of now, but several vaccines are under development and in trials. Standard measures for respiratory viruses are recommended-

  • Use of face masks
  • Frequent hand hygiene (alcohol-based disinfectants or soap and water),
  • Travel restrictions
  • Social distancing measures
  • Avoiding contact with infected patients

Prevention of transmission through gastrointenstinal tract

  • Presence of the virus in the stool raises suspicion for fecal-oral transmission of SARS-CoV-2
  • Appropriate personal protective equipment(PPE) must be used while handling sources of contamination like feces.
  • Elective appointments and endoscopies should be rescheduled and extreme care must be taken by health care professionals of the endoscopy units to avoid spreading the virus from one patient to another. [13]
  • Patients listed for fecal microbiota transplantation and donors should be screened for the SARS-CoV-2.

References

  1. ↑ https://www.cdc.gov/coronavirus/2019-ncov/about/index.html. Missing or empty |title= (help)
  2. ↑ Lu, Jian; Cui, Jie; Qian, Zhaohui; Wang, Yirong; Zhang, Hong; Duan, Yuange; Wu, Xinkai; Yao, Xinmin; Song, Yuhe; Li, Xiang; Wu, Changcheng; Tang, Xiaolu (2020). "On the origin and continuing evolution of SARS-CoV-2". National Science Review. doi:10.1093/nsr/nwaa036. ISSN 2095-5138.
  3. ↑ Huang, Chaolin; Wang, Yeming; Li, Xingwang; Ren, Lili; Zhao, Jianping; Hu, Yi; Zhang, Li; Fan, Guohui; Xu, Jiuyang; Gu, Xiaoying; Cheng, Zhenshun; Yu, Ting; Xia, Jiaan; Wei, Yuan; Wu, Wenjuan; Xie, Xuelei; Yin, Wen; Li, Hui; Liu, Min; Xiao, Yan; Gao, Hong; Guo, Li; Xie, Jungang; Wang, Guangfa; Jiang, Rongmeng; Gao, Zhancheng; Jin, Qi; Wang, Jianwei; Cao, Bin (2020). "Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China". The Lancet. 395 (10223): 497–506. doi:10.1016/S0140-6736(20)30183-5. ISSN 0140-6736.
  4. ↑ https://www.cdc.gov/coronavirus/2019-ncov/about/transmission.html. Missing or empty |title= (help)
  5. ↑ 5.0 5.1 D'Amico F, Baumgart DC, Danese S, Peyrin-Biroulet L (2020). "Diarrhea During COVID-19 Infection: Pathogenesis, Epidemiology, Prevention, and Management". Clin Gastroenterol Hepatol. doi:10.1016/j.cgh.2020.04.001. PMC 7141637 Check |pmc= value (help). PMID 32278065 Check |pmid= value (help).
  6. ↑ Liang W, Feng Z, Rao S, Xiao C, Xue X, Lin Z; et al. (2020). "Diarrhoea may be underestimated: a missing link in 2019 novel coronavirus". Gut. 69 (6): 1141–1143. doi:10.1136/gutjnl-2020-320832. PMID 32102928 Check |pmid= value (help).
  7. ↑ Wahba L, Jain N, Fire AZ, Shoura MJ, Artiles KL, McCoy MJ; et al. (2020). "An Extensive Meta-Metagenomic Search Identifies SARS-CoV-2-Homologous Sequences in Pangolin Lung Viromes". mSphere. 5 (3). doi:10.1128/mSphere.00160-20. PMC 7203451 Check |pmc= value (help). PMID 32376697 Check |pmid= value (help).
  8. ↑ 8.0 8.1 Redd WD, Zhou JC, Hathorn KE, McCarty TR, Bazarbashi AN, Thompson CC; et al. (2020). "Prevalence and Characteristics of Gastrointestinal Symptoms in Patients with SARS-CoV-2 Infection in the United States: A Multicenter Cohort Study". Gastroenterology. doi:10.1053/j.gastro.2020.04.045. PMC 7195377 Check |pmc= value (help). PMID 32333911 Check |pmid= value (help).
  9. ↑ 9.0 9.1 Luo S, Zhang X, Xu H (2020). "Don't Overlook Digestive Symptoms in Patients With 2019 Novel Coronavirus Disease (COVID-19)". Clin Gastroenterol Hepatol. 18 (7): 1636–1637. doi:10.1016/j.cgh.2020.03.043. PMC 7154217 Check |pmc= value (help). PMID 32205220 Check |pmid= value (help).
  10. ↑ Brenner EJ, Ungaro RC, Gearry RB, Kaplan GG, Kissous-Hunt M, Lewis JD; et al. (2020). "Corticosteroids, but not TNF Antagonists, are Associated with Adverse COVID-19 Outcomes in Patients With Inflammatory Bowel Diseases: Results from an International Registry". Gastroenterology. doi:10.1053/j.gastro.2020.05.032. PMC 7233252 Check |pmc= value (help). PMID 32425234 Check |pmid= value (help).
  11. ↑ Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H (2020). "Evidence for Gastrointestinal Infection of SARS-CoV-2". Gastroenterology. 158 (6): 1831–1833.e3. doi:10.1053/j.gastro.2020.02.055. PMC 7130181 Check |pmc= value (help). PMID 32142773 Check |pmid= value (help).
  12. ↑ Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J, Cao B (January 2020). "Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China". Lancet. doi:10.1016/S0140-6736(20)30183-5. PMID 31986264.
  13. ↑ Ungaro RC, Sullivan T, Colombel JF, Patel G (2020). "What Should Gastroenterologists and Patients Know About COVID-19?". Clin Gastroenterol Hepatol. 18 (7): 1409–1411. doi:10.1016/j.cgh.2020.03.020. PMC 7156804 Check |pmc= value (help). PMID 32197957 Check |pmid= value (help).


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