Editor’s note: This story has been updated regarding patient outcomes since its first posting.

Gastrointestinal symptoms are much more common in COVID-19 patients than originally thought, with nearly half presenting with digestive problems, according to a study published Wednesday in The American Journal of Gastroenterology.



While most patients do exhibit respiratory symptoms, others may have GI symptoms as their chief complaint, the authors found. Among 204 hospital patients studied, the most common issues were a marked loss of appetite (83% of study subjects), diarrhea (29%), vomiting, and abdominal pain. A few patients had no initial respiratory symptoms at all.



Digestive symptoms were also tied to worse outcomes including higher mortality risk. Patients with GI issues had a longer time between symptom onset and hospital admission, compared to their peers without these symptoms. Meanwhile, those without digestive symptoms were more likely to be cured and discharged than the cohort with gastrointestinal issues (60% versus 34%).



The takeaway? Clinicians should suspect COVID-19 when GI symptoms are present, wrote Lei Pan, M.D., Ph.D., and colleagues. In fact, GI symptoms were the chief complaint of the first coronavirus case detected in the United States, according to Medpage Today.



“If clinicians solely monitor for respiratory symptoms to establish case definitions for COVID-19, they may miss cases initially presenting with extra-pulmonary symptoms, or the disease may not be diagnosed later until respiratory symptoms emerge,” the researchers concluded.

