Global prevalence of prolonged gastrointestinal symptoms in COVID-19 survivors and potential pathogenesis: A systematic review and meta-analysis [version 1; peer review: 2 approved]
Fauzi Yusuf,
Marhami Fahriani,
Sukamto S. Mamada,
Andri Frediansyah,
Azzaki Abubakar,
Desi Maghfirah,
Jonny Karunia Fajar,
Helnida Anggun Maliga,
Muhammad Ilmawan,
Talha Bin Emran,
Youdiil Ophinni,
Meutia Rizki Innayah,
Sri Masyeni,
Abdulla Salem Bin Ghouth,
Hanifah Yusuf,
Kuldeep Dhama,
Firzan Nainu,
Harapan Harapan
Affiliations
Fauzi Yusuf
Division of Gastroenterohepatology, Department of Internal Medicine, Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, 23126, Indonesia
Marhami Fahriani
Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
Sukamto S. Mamada
Faculty of Pharmacy, Hasanuddin University, Makassar, South Sulawesi, 90245, Indonesia
Andri Frediansyah
Research Division for Natural Product Technology (BPTBA), Indonesian Institute of Sciences (LIPI), Wonosari, 55861, Indonesia
Azzaki Abubakar
Division of Gastroenterohepatology, Department of Internal Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
Desi Maghfirah
Division of Gastroenterohepatology, Department of Internal Medicine, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
Jonny Karunia Fajar
Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
Helnida Anggun Maliga
Faculty of Medicine, Universitas Brawijaya, Malang, East Java, 65117, Indonesia
Muhammad Ilmawan
Faculty of Medicine, Universitas Brawijaya, Malang, East Java, 65117, Indonesia
Talha Bin Emran
Department of Pharmacy, BGC Trust University Bangladesh, Chittagong, 4381, Bangladesh
Youdiil Ophinni
Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, 02139, USA
Meutia Rizki Innayah
YARSI Hospital, Jakarta, Indonesia
Sri Masyeni
Department of Internal Medicine, Sanjiwani Hospital, Bali, Indonesia
Abdulla Salem Bin Ghouth
Department of Community Medicine, Hadhramout University College of Medicine, Mukalla, Yemen
Hanifah Yusuf
Department of Pharmacology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
Kuldeep Dhama
Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, 243122, India
Firzan Nainu
Faculty of Pharmacy, Hasanuddin University, Makassar, South Sulawesi, 90245, Indonesia
Harapan Harapan
Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
Background: This study aimed to determine the cumulative prevalence of prolonged gastrointestinal (GI) symptoms, including nausea, vomiting, diarrhea, lack of appetite, abdominal pain, and dysgeusia, in survivors of both mild and severe COVID-19 worldwide and to discuss the potential pathogenesis. Methods: Three databases (PubMed, Scopus, and Web of Science) were searched for relevant articles up to January 30, 2021. Data on study characteristics, clinical characteristics during follow-up, the number of patients with prolonged GI symptoms, and total number of COVID-19 survivors were retrieved according to PRISMA guidelines. The quality of eligible studies was assessed using the Newcastle-Ottawa scale. The pooled prevalence of specific prolonged GI symptoms was calculated and the association between COVID-19 severity and the occurrence of prolonged GI symptoms was assessed if appropriate. Results: The global prevalence of prolonged nausea was 3.23% (95% CI: 0.54%–16.53%) among 527 COVID-19 survivors. Vomiting persisted in 93 of 2,238 COVID-19 survivors (3.19%, 95% CI: 1.62%–6.17%) and prolonged diarrhea was found in 34 of 1,073 survivors (4.12%, 95% CI: 1.07%–14.64%). A total of 156 patients among 2,238 COVID-19 survivors (4.41%, 95% CI: 1.91%–9.94%) complained of persistent decreased or loss of appetite. The cumulative prevalence of prolonged abdominal pain was 1.68% (95% CI: 0.84%–3.32%), whereas persistent dysgeusia was identified in 130 cases among 1,887 COVID-19 survivors (7.04%, 95% CI: 5.96%–8.30%). Data was insufficient to assess the relationship between COVID-19 severity and the occurrence of all prolonged GI symptoms. Conclusion: Persistent GI symptoms among COVID-19 survivors after discharge or recovery raises a concern regarding the long-term impact of the COVID-19 infection on the quality of life of the survivors. Despite several potential explanations proposed, studies that aim to follow patients after recovery from COVID-19 and determine the pathogenesis of the prolonged symptoms of COVID-19 survivors are warranted. PROSPERO registration: CRD42021239187.
