Diarrhea and other digestive symptoms are the main complaint in nearly half of coronavirus patients, Chinese researchers report. Most patients with the coronavirus have respiratory symptoms, but these findings from the early stages of the outbreak show that digestive problems are prevalent in many patients with COVID-19.

"Clinicians must bear in mind that digestive symptoms, such as diarrhea, may be a presenting feature of COVID-19, and that the index of suspicion may need to be raised earlier in these cases rather than waiting for respiratory symptoms to emerge," wrote the investigators from the Wuhan Medical Treatment Expert Group for COVID-19.

The researchers analyzed data from 204 COVID-19 patients, average age nearly 55, who were admitted to three hospitals in the Hubei province between Jan. 18 and Feb. 28, 2020. The average time from symptom onset to hospital admission was 8.1 days.

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However, the finding showed that patients with digestive symptoms had a longer time from symptom onset to hospital admission than patients without digestive symptoms, 9 days versus 7.3 days.

This suggests that patients with digestive symptoms sought care later because they didn't yet suspect they had COVID-19 due to a lack of respiratory symptoms, such as cough or shortness of breath, the researchers explained.

Patients with digestive symptoms had a variety of problems, including loss of appetite (nearly 84%), diarrhea (29%), vomiting (0.8%) and abdominal pain (0.4%).

Seven of the patients in the study had digestive symptoms but no respiratory symptoms.

As the severity of the disease increased, digestive symptoms became more serious, the researchers found.

Patients without digestive symptoms were more likely to be cured and discharged than those with digestive symptoms (60% versus 34%), according to the study published March 18 in the American Journal of Gastroenterology.

If doctors only monitor for respiratory symptoms to diagnose COVID-19, they may miss cases that initially present with other symptoms, or the disease may not be diagnosed until after respiratory symptoms emerge, the authors explained.

"In this study, COVID-19 patients with digestive symptoms have a worse clinical outcome and higher risk of [death] compared to those without digestive symptoms, emphasizing the importance of including symptoms like diarrhea to suspect COVID-19 early in the disease course before respiratory symptoms develop," Dr. Brennan Spiegel, journal co-editor-in-chief, said in a journal news release.

"This may lead to earlier diagnosis of COVID-19, which can lead to earlier treatment and more expeditious quarantine to minimize transmission from people who otherwise remain undiagnosed," Spiegel said.