GI Symptoms, Stool Viral RNA in COVID-19 Patients

GI Symptoms, Stool Viral RNA in COVID-19 Patients

October 6, 2020

Issue 19

Clinical Question

How common are gastrointestinal symptoms and stool SARS-CoV-2 RNA in COVID-19 patients?

Editor’s Bottom Line

Gastrointestinal symptoms are common among patients with SARS-CoV-2 infection, and viral RNA may persist in stool after it clears from the respiratory tract. However, the clinical significance of viral persistence in stool samples needs further study.


Cheung SK, Hung IFN, Chan PPY, et al. Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples From a Hong Kong Cohort: Systematic Review and Meta-analysis. Gastroenterol. 2020;159(1):81–95;


This systematic review and meta-analysis documented the prevalence of gastrointestinal symptoms and SARS-CoV-2 virus in stool among COVID-19 patients. The analysis included data from 4,243 patients with symptomatic COVID-19 in 60 published studies from six countries. The publication also included a cohort analysis of 59 patients with COVID-19 treated in Hong Kong in February, 2020.

Authors documented the overall prevalence of gastrointestinal symptoms as well as specific symptoms, including loss of appetite, nausea, vomiting, diarrhea, and abdominal pain or discomfort.

Their findings showed that 25% of the 59-patient cohort in Hong Kong had gastrointestinal symptoms, most commonly diarrhea and abdominal pain, while the meta-analysis revealed a prevalence of 17.6% for gastrointestinal symptoms. Twenty-five percent of pediatric patients had gastrointestinal symptoms, compared to 17% of adults, and 20% of pregnant women.

Findings also showed that 15% of those in the Hong Kong cohort had SARS-CoV-2 RNA in their stool, and over 38% of these RNA-positive patients had diarrhea, compared to 8.7% who did not have diarrhea and had RNA-positive stool (p=0.02). Meta-analysis revealed that 48.1% of patients had stool samples positive for SARS-CoV-2 virus RNA. In serial follow up of such patients, 70.3% had persistent RNA-positive after respiratory specimens tested negative.

The researchers urged caution in collecting fecal samples or performing endoscopic procedures in patients with COVID-19, “even during patient recovery.”


Study Design: Mixed retrospective meta-analysis and cohort study

Funding: Not noted

Allocation: Not applicable

Setting: Multicenter

Level of Evidence: 2a for meta-analysis and 1b for cohort study (Oxford Levels of Evidence)