Proctitis and Other Gastrointestinal Manifestations in Mpox Disease: A Systematic Review and Meta-Analysis

Background

Mpox, caused by the monkeypox virus (MPXV), is primarily recognized for its dermatologic and systemic symptoms. However, emerging evidence suggests a significant prevalence of gastrointestinal (GI) manifestations, particularly proctitis, diarrhea, nausea, vomiting, and abdominal pain. Despite the growing clinical recognition of these symptoms, their epidemiology and impact remain poorly understood. This systematic review and meta-analysis aim to quantify the prevalence of GI manifestations in Mpox patients and assess their clinical significance.

Methods

A systematic review following PRISMA guidelines was conducted across PubMed, Embase, and Web of Science, including quantitative studies published up until October 2024 that reported GI manifestations in Mpox patients. Screening and data extraction were performed using Nested Knowledge software, and study quality was assessed using the Newcastle–Ottawa Scale. Meta-analysis was conducted using R version 4.4, with heterogeneity evaluated via the I² statistic. Sensitivity analyses and publication bias were assessed using Doi plots and the Luis Furuya-Kanamori (LFK) index.

Results

Out of 1229 records, 33 studies met the eligibility criteria, yielding a pooled prevalence of proctitis in Mpox patients at 24.75% (95% CI: 18.93%–31.04%) across 5878 participants, with high heterogeneity (I² = 94.8%). The prediction interval for proctitis ranged from 1.46% to 61.76%. The pooled prevalence of other GI manifestations was 30.45% (95% CI: 18.27%–44.14%) across 2237 participants, with significant heterogeneity (I² = 95.2%) and a prediction interval ranging from 0.00% to 85.28%. Sensitivity analyses confirmed the stability of these estimates, while publication bias was indicated by LFK index values exceeding 2.77.

Conclusions

This meta-analysis highlights the substantial burden of GI manifestations in Mpox, particularly proctitis, with considerable variability across studies. The findings underscore the need for standardized diagnostic criteria and increased clinical recognition of GI symptoms in Mpox management. Further research into the underlying pathophysiology and integrating GI symptom assessment into Mpox surveillance and treatment strategies could enhance diagnostic accuracy and patient care outcomes.