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).