Gastrointestinal (GI) symptoms associated with SARS-CoV-2 infection and subsequent coronavirus disease 2019 (COVID-19) were prevalent presenting symptoms in 63% of patients with active cancer, according to the results of a cohort study published in the Journal of Clinical Gastroenterology.1

GI symptoms are known to occur with SARS-CoV-2 infection and can present independently of respiratory symptoms, but the prevalence of GI manifestations among patients with cancer is unknown. The aim of this study was to characterize GI symptoms associated with COVID-19 in this population.

The multicenter, observational study identified 36 patients with active cancer among 395 patients hospitalized with COVID-19 between January and April 2020 in Massachusetts. All patients had confirmed SARS-CoV-2 infection by polymerase chain reaction (PCR) nasopharyngeal swab or tracheal aspirate testing, and all patients had active cancer. Sixty-four percent of patients were receiving anticancer therapy.

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At least 1 GI symptom was reported at COVID-19 presentation in 63% of patients. GI symptoms were the initial symptoms in 11% of patients predominant in 14% of patients, and severe in 17% of patients. Nausea (52%), anorexia (52%), diarrhea (39%), vomiting (35%), and abdominal pain (26%) were the most common GI symptoms. One patient reported GI symptoms and no fever or respiratory symptoms.

Liver transaminase elevations were also common, occurring among 33% of patients at presentation, including among 50% of patients with no prior liver disease. GI symptoms were significantly associated with liver transaminase elevations, which was present in 83% of patients with GI symptoms compared with 54% of patients with no GI symptoms (P =.04).Other common symptoms at presentation included fever (81%), cough (70%), dyspnea (44%), and fatigue (57%).

In the cohort, 42% of patients required intensive care; 17% necessitated mechanical ventilation. Death occurred among 22% of patients. GI symptoms were not found to be associated with severity of disease or death.

The authors concluded that, among patients with cancer, “acute GI symptoms associated with COVID-19 were highly prevalent and occurred as a presenting symptom without respiratory symptoms.” They acknowledged that further studies are needed to validate these results.


  1. Grover S, Redd WD, Zhou JC, et al. High prevalence of gastrointestinal manifestations of COVID-19 infection in hospitalized patients with cancer. J Clin Gastroenterol. 2021;55(1):84-87. doi:10.1097/MCG.0000000000001462