Digestive system involvement of infections with SARS-CoV-2 and other coronaviruses: Clinical manifestations and potential mechanisms

Table 1 Presentation of gastrointestinal symptoms, abnormal liver function, and pre-existing digestive diseases in patients with severe acute respiratory syndrome coronavirus 2 infection

Ref.	Patients with COVID-19	Gastrointestinal symptoms			Patients with abnormal biochemical indicators of liver function	Patients with pre-existing digestive diseases	Patients testing positive for SARS-CoV-2 in stool or rectal swab specimens
		Diarrhoea	Nausea and vomiting	Abdominal pain
Guan et al[7]	1099	42 (3.8%)	55 (5.0%)	NA	Abnormal AST: 168/757 (22.2%). Abnormal ALT: 158/741 (21.3%). Abnormal TBIL: 76/722 (10.5%)	CHB: 23 (2.1%)	Stool specimens: 4/NA. Rectal swab: 4/NA
Wang et al[6]	138	14 (10.1%)	19 (13.7%)	3 (2.2%)	Mild elevation of AST and ALT	4 (2.9%)	NA
Huang et al[40]	41	1/38 (2.6%)	NA	NA	Abnormal AST: 15 (31.0%)	Chronic liver disease: 1 (2%)	NA
Fan et al[116]	148	6 (4.1%)	3 (2.0%)	NA	Abnormal AST: 32 (21.6%). Abnormal ALT: 27 (18.2%). Abnormal TBIL: 9 (6.1%)	9 (6.1%)	NA
Cai et al[49]	298	9 (3.0%)	NA	NA	Abnormal AST: 25 (8.4%). Abnormal ALT: 39 (13.1%). Abnormal TBIL: 24 (8.1%)	CHB: 5 (1.7%). NAFLD: 14 (4.7%). ALD: 9 (3.0%)	NA
Chen et al[3]	99	2 (2.0%)	1 (1.0%)	NA	Abnormal AST: 35 (35.0%). Abnormal ALT: 28 (28.0%). Abnormal TBIL: 18 (18.0%). Abnormal albumin: 97 (98.0%)	NA	NA
Holshue et al[41]	1	1	1	NA	Abnormal AST: 1. Abnormal ALT: 1. Abnormal TBIL: 1. Abnormal albumin: 1	NA	Stool specimens: 1/1
Zhang et al[117]	140	18/139 (12.9%)	31/139 (22.3%)	8/139 (5.8%)	NA	FLD and abnormal liver function: 8 (5.7%). Chronic gastritis and gastric ulcer: 7 (5.0%). Cholelithiasis: 6 (4.3%)	NA
Xiao et al[10]	73	26 (35.6%)	NA	NA	NA	NA	Stool specimens: 39/73 (53.4%)
Zhou et al[118]	191	9 (4.7%)	7 (3.7%)	NA	Abnormal ALT: 59/189 (31.2%)	NA	NA
Zhang et al[119]	82 (Deaths)	10 (12.2%)	2 (2.3%)	NA	Abnormal AST: 44/72 (61.1%). Abnormal ALT: 22/72 (30.6%). Abnormal TBIL: 22/72 (30.6%). Abnormal albumin: 56/72 (77.8%)	Liver disease: 2/82 (2.4%)	NA
Xu et al[120]	62	3 (4.8%)	NA	NA	Abnormal AST: 10 (16.1%)	Liver disease: 7 (11.3%)	NA
Chen et al[121]	21	4/20 (20.0%)	NA	NA	Abnormal AST: 6 (28.6%). Abnormal albumin: 8 (38.1%)	NA	NA
Pan et al[11]	204	29 (14.2%)	8 (3.9%)	4 (2.0%)	Abnormal AST: NA. Abnormal albumin: NA	CHB: 1 (0.5%). FLD: 1 (0.5%). Gastritis: 1 (0.5%)	NA
Luo et al[122]	1141	68 (5.9%)	Nausea: 134 (11.7%). Vomiting: 119 (10.4%)	45 (3.9%)	Mild elevation of AST and ALT	NA	NA
Total	3738	174/2592 (6.7%)

ALD: Alcoholic fatty liver disease; ALT: Alanine transaminase; AST: Aspartate aminotransferase; CHB: Chronic hepatitis B; COVID-19: Coronavirus disease 2019; FLD: Fatty liver disease; NAFLD: Non-alcoholic fatty liver disease; SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2; TBIL: Total bilirubin.