Dr Vincent Ho
The case of a Queensland nurse who correctly suspected he had COVID-19 disease based only on abdominal pain symptoms has raised the question of whether people with atypical GI symptoms alone should be encouraged to have coronavirus testing.
The 37-year old man had been working in close contact with COVID-19 patients at Ipswich Hospital and sought testing despite having none of the classic symptoms of cough, fever or fatigue.
State health minister Health Minister Steven Miles said the man was “incredibly wise” to have identified abdominal pain as a possible sign of COVID-19 and said it set a good example for people to have a low index of suspicion for COVID-19.
“It underlines how we can all do the right things by monitoring our health and if we have any symptoms at all that are of any cause for concern, we can go and get tested.”
The message was reinforced by Queensland Premier Annastacia Palaszczuk who said anyone who had even mild or rare symptoms of COVID-19 should stay home and get tested as soon as possible.
But Dr Vincent Ho, Senior Lecturer and clinical academic gastroenterologist, Western Sydney University, says there is no strong evidence to support COVID-19 testing for most people with GI symptoms alone unless there are other risk factors such as having close contact with a COVID-19 positive person.
Writing in the Conversation, he says there are good reasons to believe there will be gastrointestinal manifestations with COVID-19 because of the high levels of ACE2 receptors in the gut.
Current evidence suggests that about 18% of people with COVID-19 have gastrointestinal symptoms, he says, with diarrhoea, nausea and vomiting listed alongside other classic symptoms in Australian guidance.
But abdominal pain is a much less common symptom of coronavirus infection, reported in only about 2% of patients with COVID-19 according to one study.
With low community rates of circulating COVID-19, the vast majority of people with GI symptoms such as abdominal pain are likely to have conditions such as dyspepsia or IBS, he writes.
The pre-test probability of COVID-19 is likely to be low for most people with only GI symptoms.
He advises that people with GI symptoms should definitely get tested if they have potentially been in contact with someone with COVID-19 or also have other classic COVID-19 symptoms.
Similarly, people with GI symptoms should consider testing if they are in a COVID-19 “hotspot” area, or work in a high-risk occupation or industry.
“If you have gastrointestinal symptoms alone, without any of these additional risk factors, there is no strong evidence to support testing,” he concludes.
People should also be aware that the GI involvement of coronavirus means it can be transmitted via the faecal-oral route and it may persist in the gut for some time after respiratory symptoms have resolved, adds Dr Ho.