Coronavirus Update

• Digestive symptoms, e.g. diarrhoea, are common in COVID-19 in addition to fever and respiratory symptoms, and are reported in nearly half of patients presenting to hospital (103 out of the 204 patients studied); in rare cases, digestive symptoms may occur in the absence of any respiratory symptoms
• Focusing on diarrhoea symptoms, 17% of COVID-19 patients in this series reported loose stools
• COVID-19 patients with digestive symptoms have laboratory evidence of prolonged coagulation (blood clotting) and higher liver tests compared to those without digestive symptoms, emphasising the importance of including symptoms like diarrhoea to diagnose COVID-19 early

A recent study led by Prof. Nan-Shan Zhong’s team, by sampling 1099 laboratory-confirmed cases, found that the common clinical manifestations included fever (88.7%), cough (67.8%), fatigue (38.1%), sputum production (33.4%), shortness of breath (18.6%), sore throat (13.9%), and headache (13.6%) [16]. In addition, some patients experienced gastrointestinal symptoms, with diarrhoea (3.8%) and vomiting (5.0%).

The Russian Ministry of Health has produced a guidance on the prevention, diagnostics and treatment of new coronavirus infection which includes recommendation to use enterosorbents (Enterosgel) for “intoxication, discomfort in your abdomen, nausea and/or vomiting, bloating that interfere with your consumption of liquids”.

There have been two studies in Russia on Enterosgel use as a therapy for viral gastrointestinal infection. One study investigated efficacy in norovirus infection in children and showed greater relief of symptoms than the comparable antibiotic group. The second study of rotavirus infection in newborn children demonstrated that in the Enterosgel group, RV antigen content in the faeces decreased rapidly and was absent by day 4, alongside a reduction in the duration of diarrhoea and a shorter inpatient stay.

For those patients with gastrointestinal symptoms, Enterosgel could provide a treatment option to reduce diarrhoeal symptoms or vomiting, the mechanism of action could involve binding of viral particles from the gut and removal in the stools, thus relieving symptoms.

Since the start of the COVID-19 outbreak, digestive symptoms have been frequently reported by infected patients. A study by Pan et el. across 3 hospitals in Hubei province, China, investigating 204 severe COVID-19 patients has just released results showing that digestive symptoms, including diarrhoea, vomiting, and abdominal pain, were common amongst these patients (experienced by 103 patients). Their analyses showed that COVID-19 patients with digestive symptoms had a significantly longer delay time from onset of the viral infection to admission for treatment, 9 days compared to the 7.3 days for patients not experiencing digestive symptoms. 6 patients infected with COVID-19 experienced only digestive symptoms and no respiratory symptoms.

Patients with higher severity of infection presented more pronounced digestive symptoms. The study also revealed that those experiencing digestive symptoms exhibited slower blood clotting, had a lower white blood cell count, and displayed higher average liver enzymes level, therefore an increased likelihood of suffering liver injury.

The results emphasise the need to advise clinicians to recognise digestive symptoms, such as diarrhoea, as being common symptoms presenting in patients with COVID-19, in order to identify potential cases of infection earlier. They emphasise that “clinicians should recognise that digestive symptoms, such as diarrhoea, are commonly among the presenting features of COVID-19, and that the index of suspicion may need to be raised earlier in at-risk patients presenting with digestive symptoms.” Further studies would be valuable for providing further support and clarification on this topic.

Stay Safe Out There

Enterosgel is available from Holland & Barrett, Boots, Lloyds Pharmacy and your local pharmacies and health stores!