Gastrointestinal and Liver Manifestations in Monkeypox Patients
All studies included in this systematic review reported at least one GI
manifestation; however, there were only two studies that reported liver
manifestations in Mpox patients and so were not included in the
meta-analysis [16, 24]. The five most reported GI manifestations
were: (1) Nausea and/or Vomiting (17 studies); (2) Proctitis (15
studies); (3) Diarrhea (11 studies); (4) Abdominal Pain (9 studies); (5)
Anorexia (3 studies). The other GI and/or liver manifestations reported
were summarized in Table S6 . The overall pooled prevalence for
abdominal pain, anorexia, diarrhea, nausea and/or vomiting, and
proctitis were 9% (95%CI 8-10%), 47% (95%CI 41-53%), 5% (95%CI
4-6%), 12% (95%CI 11-13%), and 11% (95%CI 11-12%), respectively
(Figure 2 ). All manifestations but diarrhea
(I2=27%) were heterogeneous among studies, with
I2 ranging from 78%-93%. The Funnel Plot analysis
showed asymmetry suggesting a potential risk for publication bias;
however, Egger’s test indicated that quantitatively there was no risk of
publication bias (p=0.35).
Subgroup analysis was done to explore whether there were differences in
the overall prevalence based on study location and age group
(Table S7 ). A higher prevalence of abdominal pain was reported
in African studies (24%; 95%CI 19-30%) vs. Non-African studies (8%;
95% 7-9%) (p-interaction<0.0001). Additionally, nausea
and/or vomiting were more frequently reported in African studies (16%;
95%CI 15-18%) compared to Non-African studies (9%; 95%CI 8-10%)
(p-interaction<0.0001). However, no difference in the overall
prevalence of diarrhea was found between the two groups
(p-interaction=0.10). Additionally, in comparison to the mixed
population, studies that included only adult patients reported
significantly decreased prevalence of abdominal pain (8%; 95% 7-9%
vs. 22%; 95%CI 18-28%), anorexia (10%; 95%CI 2-31% vs. 50%;
95%CI 44-57%), diarrhea (3%; 95%CI 2-5% vs. 6%; 95%CI 5-8%) and
nausea and/or vomiting (9%; 95%CI 8-10% vs. 17%; 95%CI 15-19%)
(p-interaction<0.10).