Thread by @BrennanSpiegel

Breaking #COVID19 Data – Please Share (1/10): On behalf of @AmCollegeGastro, our editorial team at #AmJGastro just released a study from Wuhan, China reporting 48.5% of patients presented to hospital with a digestive symptom as their chief complaint. Coronavirus is #NotJustCough.

(2/10) One in 5 presented with either diarrhea, nausea, vomiting or belly pain as the presenting complaint. “Clinicians must bear in mind,” write the authors, “that digestive symptoms, such as diarrhea, may be a presenting feature of #COVID-19, & that the index of suspicion may…

(3/10) …need to be raised earlier in these cases rather than waiting for respiratory symptoms to emerge.” Moreover, patients with digestive symptoms had a worse clinical outcome and higher mortality. Emphasizes importance of including symptoms like diarrhea to suspect #COVID19.

(4/10) Currently, symptoms like diarrhea are not part of the #COVID19 diagnostic checklist. But new data suggest it’s more common than thought. Authors write: “If clinicians solely monitor for respiratory symptoms to establish case definitions, they may miss cases initially…

(5/10) …presenting with extra-pulmonary symptoms, or the disease may not be diagnosed later until respiratory symptoms emerge.” Another key finding: Patients with digestive symptoms had longer time from onset to hospital admission. This may indicate that patients with…

(6/10) …non-respiratory symptoms like diarrhea seek care later b/c they and their doctors didn’t yet suspect #COVID19. In rare instances (3%) patients presented only with digestive symptoms and respiratory symptoms never emerged, but most eventually developed lung symptoms.

(7/10) If we add diarrhea to checklist of symptoms in at-risk patients, such as those with #COVID19 contact, we might diagnose earlier, which can lead to earlier treatment and more expeditious quarantine to minimize transmission. Of course, we cannot nor should not test…

(8/10) …for #COVID19 in every person with diarrhea, nausea, vomiting, low appetite, or abdominal pain. Those are very common symptoms. But if one of those develops w/ a fever in someone with a known or suspected #COVID19 contact, these new results suggest that testing could be…

(9/10) …warranted. Coronavirus is #NotJustCough. That said, we must defer to CDC guidance as they evaluate the new data from this study and others. Here are resources for more information on GI manifestations of #COVID-19:

(10/10) Our full statement from @AmCollegeGastro: gi.org/wp-content/upl…. Link to full article from Wuhan: journals.lww.com/ajg/Documents/…. Link to joint statement from all four GI societies, including @AmCollegeGastro @AmerGastroAssn @AASLDtweets @ASGEendoscopy: gi.org/2020/03/15/joi…