Gastrointestinal Manifestations of the COVID-19: A Systematic Review and MetaAnalysis with 111 studies

Introduction: Since the start of a pandemic from Wuhan, China in 2019, there is tremendous attention on the COVID-19 manifestation. One of the most important COVID-19 clinical presentations is gastrointestinal symptoms. The current systematic review study aims to focus on the implication of the gastrointestinal tract in patients infected with SARS-CoV-2. Methods: We searched literature in MEDLINE, Scopus, Web of Science, and Embase to find related article by using the following keywords "COVID-19", "SARS-CoV-2 infection", "Gastrointestinal Tract", "digestive system". The heterogeneity of included studies was quantified with the I2 statistic. A random-effects model was used to estimate the pooled prevalence and a meta-regression method was utilized to investigate the factors affecting heterogeneity between studies. Results: Of 3028 retrieved documents, 111 studies with 21126 COVID-19 cases were included. The prevalence of any Gastrointestinal symptoms was 17.22% (14.48 to 20.13). The prevalence of diarrhea was 13.75% (12.07 to 15.44), anorexia 27.41% (21.53 to 33.29) and Nausea/vomiting 8.11% (6.87 to 9.35). Furthermore, the prevalence of other symptoms in current study was fever 76.70% (73.42 to 79.83), cough 58.07% (54.59 to 61.52) and dyspnea/shortness of breath 24.63% (20.06 to 29.48). According to meta-regression results, age (p: 0.027) and fever (p<0.001) had significant effect on prevalence of any Gastrointestinal symptoms. Conclusion: The anorexia, diarrhea, nausea, and vomiting are the most common Gastrointestinal presentations.