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GI Manifestations of COVID

Taylor Riggs


  • GI manifestations are reported up to 60% of patients with COVID
  • GI symptoms may be the only symptom or precede other symptoms
  • GI manifestations are felt to be due to expression of ACE2 receptor throughout the GI tract


  • Diarrhea – more common in severe disease
  • ~20% have diarrhea as first symptom of COVID; on average, lasts about 5 days
  • Nausea and vomiting – associated with more severe disease
  • Mesenteric ischemia – likely due to intestinal microvascular injury
  • Elevated liver enzymes – likely due to inflammatory response and direct virus-related toxicity
  • Hepatocellular pattern of injury most common; elevated bilirubin seen in severe disease
  • Usually self-limited
  • Pancreatitis has been reported in several cases, but no causal link has been established


  • Largely supportive care
  • Monitor LFTs, coags, consider checking lipase if abdominal pain
  • If LFTs not improving after several days or underlying chronic liver disease, obtain RUQ U/S, consider hepatitis serologies
  • Consider medications/antiviral medications as culprit and discontinue as indicated