Gut Diseases Increase After COVID-19 Infection and Hospitalization

New-onset disorders of gut-brain interaction should be anticipated following infection with COVID-19, and especially after hospitalization for this disease, according to a paper published in Gut.

Investigators from Italy prospectively and consecutively enrolled 883 eligible hospital patients with and without COVID-19 between May and October 2020 to evaluate the long-term consequences of COVID-19 infection on the gastrointestinal tract.

Patients involved in the study were evaluated upon hospital admission, as well as after 1, 6, and 12 months post-hospitalization. Using questionnaires, the study participants were assessed for gastrointestinal symptoms, anxiety, and depression.

There were 614 COVID-19 patients included in the analysis. The control group was made up of 269 patients that were admitted to the hospital for reasons other than COVID-19, which included symptoms such as gastroenterological, traumatic, and surgical pertinence.

The study authors explained that compared to non-infected controls, another study they conducted on this subject showed COVID-19 can contribute to diarrhea, nausea, and other gastrointestinal symptoms. There was also a greater prevalence of nausea and acid regurgitation compared to controls 1 month after post-initial assessment.

Gastrointestinal symptoms appeared more frequently in patients with COVID-19 compared to controls at baseline, the study authors said, observing almost 40% of controls compared to almost 60% of COVID-19 patients. These COVID-19 patients reported higher rates of nausea, diarrhea, loose stools, urgency, and a lower rate of hard stools compared to control subjects.

After 1 month, COVID-19 patients still showed significantly higher rates of nausea and acid regurgitation, compared to the control patients.

Follow up was completed by 772 patients (548 COVID-19 and 224 controls) at 6 months, and by 623 patients (435 COVID-19 and 188 controls) at 12 months.

At the 6-month mark, COVID-19 patients reported lower rates of flatus, constipation, and hard stools compared to control patients. At this point, there were no significant differences between the groups in terms of epigastric pain syndrome, post-prandial distress syndrome, functional dyspepsia, IBS, and functional diarrhea.

After a year, COVID-19 patients reported significantly lower rates of constipation and hard stools compared to control patients, the study authors reported. But COVID-19 patients had higher rates of IBS at this point, compared to just a single control patient who developed IBS at the 12-month mark. IBS risk was increased among patients in either group with a history of allergies, chronic intake of PPI, dyspnea at hospitalization. Their rate is in line with data from a recent meta-analysis

Depression and anxiety rates were both higher in the COVID-19 patient group compared to the control group, the investigators found.

“COVID-19 is associated with a modest increased risk of long-term gastrointestinal symptoms and IBS,” the study authors wrote. “Given the high prevalence of COVID-19 at the global level, an increase in new-onset disorders of gut-brain interaction should be expected due to COVID-19, especially after hospitalization for this disease. Future studies are needed to improve our understanding of the mechanisms underlying symptom development in these patients, and to identify novel therapeutic strategies to prevent and treat these conditions.”