Background: COVID-19 pandemic or coronavirus is a systemic disease taken into consideration for vascular

system-specific tropism where microcirculation alteration has a significant pathogenic role. The coronavirus

affects the gastrointestinal tract, abdominal manifestation, and hepatobiliary system.

Aim: the aim of the present study was to evaluate the association of gastrointestinal symptoms with unfavorable

prognosis of coronavirus patients.

Materials and Methods: This single-center cross-sectional study was carried out on 486 patients with or without

gastrointestinal symptoms and was conducted for six months duration from January to June 2021 at

Gastroenterology department, Isra University Hospital, Hyderabad. All these patients were categorized into two

main groups; group-I patients exposed to coronavirus with gastrointestinal symptoms while group-II patients

exposed to COVID-19 without gastrointestinal symptoms. Gastrointestinal symptoms were associated with acute

respiratory distress syndrome (ARDS), continuous renal replacement therapy (CRRT), non-invasive ventilator

treatment, tracheotomy, and tracheal intubation. Multivariable and unilateral regression models were utilized for

data analysis.

Results: Of the total 486 patients, 157 (32.3%) were with gastrointestinal symptom patients while 329 (67.7%)

were without GI symptoms. Propensity scores were analyzed in both groups. Both groups were equally

susceptible to higher mortality risks but COVID-19 patients with gastrointestinal symptoms were at high risk of

acute respiratory distress syndrome. Of the 157 patients with GI symptoms, 44 (28.03%) were initially diagnosed

and 113 (71.97%) were diagnosed in hospital. The prevalence of vomiting or nausea, diarrhea, abdominal

distention, and abdominal pain were 30 (19.1%), 83 (52.9%), 18 (11.5%), and 26 (16.6%) respectively. Dyspnea,

fatigue, fever, chest tightness, and cough were common COVID-19 symptomatic patients. The prevalence of GI

symptoms patients had dyspnea 23 (14.6%), fatigue 45 (28.7%), fever 128 (81.5%), chest tightness 25 (15.9%),

and cough 72 (45.9%) were statistically significant and higher compared to the no symptoms of gastrointestinal

disease patients.

Conclusion: Our study found the high prevalence of COVID-19 patients with gastrointestinal symptoms

compared to without gastrointestinal symptoms in COVID-19 patients and associated with non-invasive

mechanical ventilation and risks of acute respiratory distress syndrome. Hence, COVID-19 patients with

gastrointestinal symptoms should be taken care of in healthcare protection.

Keywords: COVID-19, Gastrointestinal symptoms, ARDS or acute respiratory distress syndrome