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INTRODUCTION: Since its emergence in Wuhan, China in late 2019, COVID-19 has become a global pandemic Initially defined predominantly by respiratory symptoms, it is now well understood that COVID-19 affects multiple systems Gastrointestinal (GI) symptoms have been identified in these patients and in some patients, these are the only presenting symptoms Therefore, it is vital that we identify and understand the GI symptoms associated for prompt diagnosis and management We [200] Figure 1 Forest plot of studies with odd's ratio (OR 1 63, 95% CI: 1 11-2 38, P = 0 01) conducted a systematic review and meta-analysis to identify the GI symptoms of COVID-19 and its association with disease severity METHODS: We searched Medline and Embase from December 2019 to May 2020 to identify articles reporting GI symptoms in COVID-19 patients The primary outcome was prevalence of GI symptoms in COVID-19 patients, and secondary outcome was the association of GI symptoms with disease severity RESULTS: A total of 38 studies with 8,407 patients were included Of the total patients, 15 47% patients had at least one GI symptom The pooled prevalence of nausea/vomiting was 7 53% and diarrhea was 11 52% (Table 1) On meta-analysis, patients with diarrhea as one of the presenting symptoms were more likely to have severe disease (OR 1 63, 95% CI: 1 11-3 38, P = 0 01) as shown in Figure 1 CONCLUSION: Our systematic review and meta-analysis demonstrated that GI symptoms are common in COVID-19 patients with diarrhea and nausea/vomiting being the predominant symptoms Presence of diarrhea as a presenting symptom is associated with increased disease severity and likely worse prognosis Patients with diarrhea likely harbor increased viral load, which can potentially lead to an increased systemic response to the virus and associated respiratory complications from it Early recognition of patients is needed for prompt management of this at-risk population