COVID-19-induced gastrointestinal autonomic dysfunction: A systematic review

Table 7 Differential diagnosis of gastrointestinal autonomic dysfunction in patients with coronavirus disease 2019

Condition		Comments
Gastrointestinal disorders	Gastrointestinal dysmotility	Gastrointestinal dysmotility refers to abnormal movement in the digestive system that can cause symptoms such as nausea, vomiting, abdominal pain, and bloating. COVID-19-induced gastrointestinal autonomic dysfunction can cause similar symptoms, making it essential to distinguish between the two
	Gastroesophageal Reflux disease	Gastroesophageal reflux disease is a common condition that occurs when stomach acid flows back into the esophagus, causing heartburn and other symptoms. It can be diagnosed by an upper endoscopy or an esophageal pH test
	Gastroparesis	Gastroparesis is a disorder in which the stomach takes too long to empty its contents, causing symptoms such as nausea, vomiting, and bloating
	Gastritis	This condition is inflammation of the gastric mucosa. It can cause abdominal pain, nausea, and vomiting
	Peptic ulcer disease	This condition is characterized by sores in the lining of the stomach or duodenum and can cause abdominal pain and vomiting
	Gastrointestinal infections	Viral, bacterial, or parasitic infections can cause similar symptoms to COVID-19-induced gastrointestinal autonomic disorders and may require specific testing and treatment. For example: Other viral infections, such as norovirus, adenovirus, and rotavirus, can also cause gastrointestinal symptoms like COVID-19-induced gastrointestinal autonomic disorders. Considering these infections in the differential diagnosis is important, especially if the patient has a recent travel history or exposure to infected individuals. Some bacterial infections, such as Clostridium difficile infection, can cause gastrointestinal symptoms like those of COVID-19. Clostridium difficile infection can also cause autonomic dysfunction, leading to symptoms such as dizziness and fainting. Other bacteria like Salmonella, Shigella, Campylobacter, and Escherichia coli can produce gastrointestinal symptoms. Parasitic infections such as infection with Giardia lamblia, Entamoeba histolytica, and Cryptosporidium can cause diarrhea and other gastrointestinal symptoms
	Acute pancreatitis	This condition can cause abdominal pain, vomiting, and diarrhea, which may be like COVID-19-induced gastrointestinal autonomic dysfunction. Blood tests and imaging studies can help diagnose pancreatitis
	Gallstones	Gallstones can cause abdominal pain, nausea, and vomiting
	Cholecystitis	It is gallbladder inflammation, which can cause symptoms such as abdominal pain, nausea, vomiting, and fever
	Inflammatory bowel disease	Crohn's disease and ulcerative colitis can cause diarrhea, abdominal pain, and vomiting, which may be like COVID-19-induced gastrointestinal autonomic dysfunction. Endoscopy and stool tests can help to distinguish inflammatory bowel disease from other causes
	Irritable bowel syndrome	Irritable bowel syndrome is a chronic condition that causes abdominal pain, bloating, and changes in bowel habits. These symptoms may be similar to COVID-19-induced gastrointestinal autonomic dysfunction, but irritable bowel syndrome is a non-inflammatory condition
	Post-infectious irritable bowel syndrome	Post-infectious irritable bowel syndrome is a subtype of irritable bowel syndrome that occurs following an infection. This condition can cause similar symptoms to COVID-19-induced gastrointestinal autonomic dysfunction
	Celiac disease	Celiac disease is an autoimmune disorder that affects the small intestine, causing symptoms such as diarrhea, abdominal pain, and bloating
	Small intestinal bacterial overgrowth	Small intestinal bacterial overgrowth is a condition in which there is an overgrowth of bacteria in the small intestine, leading to symptoms such as diarrhea, bloating, and abdominal pain. It can be diagnosed through a breath test and a physical exam
	Gastrointestinal malignancies	Gastrointestinal malignancies such as colon cancer, gastric cancer, or pancreatic cancer, can cause abdominal pain, bloating, nausea, vomiting, and changes in bowel habits
Food-related disorders	Food poisoning	Food poisoning is a bacterial or viral infection caused by consuming contaminated food, causing symptoms such as diarrhea, nausea, vomiting, and abdominal pain
	Food intolerance	Lactose intolerance or gluten intolerance can cause gastrointestinal symptoms
Endocrine disorders	Hyperthyroidism, diabetes, adrenal insufficiency	Certain hormonal imbalances, such as hyperthyroidism, diabetes, or adrenal insufficiency, can cause gastrointestinal symptoms and autonomic dysfunction. For example, in diabetic neuropathy, diabetes can damage the nerves that control the gastrointestinal system, leading to symptoms such as delayed gastric emptying and gastroparesis. Diabetic gastroparesis symptoms include nausea, vomiting, bloating, and early satiety
Psychiatric disorders	Stress, anxiety, somatization disorders, depression	Conditions such as stress, anxiety, somatization disorders, and depression can cause gastrointestinal symptoms such as nausea and vomiting and symptoms of autonomic dysfunction, such as rapid heartbeat and sweating. It is essential to assess the patient's mental health and history of psychiatric disorders to determine if psychological factors may contribute to the patient's presentation
Neurological disorders	Parkinson's disease, multiple sclerosis, multiple system atrophy, pure autonomic failure	Certain neurological disorders can cause autonomic dysfunction, including Parkinson's disease, multiple sclerosis, multiple system atrophy, and pure autonomic failure. For example, Parkinson's disease can cause gastrointestinal symptoms such as constipation and difficulty swallowing
Autonomic nervous system dysfunction	Postural orthostatic tachycardia syndrome	Postural orthostatic tachycardia syndrome is a condition that causes an abnormal increase in heart rate when changing position from lying down to standing up. Symptoms can include gastrointestinal symptoms such as nausea, vomiting, and abdominal pain
	Autonomic neuropathy	Autonomic neuropathy is a condition that affects the nerves that control the body’s automatic functions, including the gastrointestinal system. It can cause symptoms such as delayed gastric emptying, constipation, and gastroparesis
Metabolic disorders		Metabolic disorders such as liver disease, kidney disease, and electrolyte imbalances can cause gastrointestinal and autonomic symptoms
Medications		Certain medications include opioids, anticholinergics, antibiotics, antihypertensives (e.g., calcium channel and beta blockers), nonsteroidal anti-inflammatory drugs, corticosteroids, chemotherapy drugs, and proton pump inhibitors, which can cause gastrointestinal symptoms

COVID-19: Coronavirus disease 2019.