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People who have had COVID-19 have a 36% overall higher risk of developing gastrointestinal (GI) problems in the year after infection than people who have not had the illness, a large new study indicates.
The researchers estimate that, so far, SARS-CoV-2 infections have contributed to more than 6 million new cases of GI disorders in the United States and 42 million new cases worldwide.
The diagnoses more common among patients who’ve had COVID ranged from stomach upset to acute pancreatitis, say the researchers, led by Evan Xu, a data analyst at the Clinical Epidemiology Center, Research and Development Service, the VA St. Louis Health Care System in Missouri.
Signs and symptoms of GI problems, such as constipation and diarrhea, also were more common among patients who had had the virus, the study found.
“Altogether, our results show that people with SARS-CoV-2 infection are at increased risk of gastrointestinal disorders in the post-acute phase of COVID-19,” the researchers write. “Post-COVID care should involve attention to gastrointestinal health and disease.”
The results were published online in Nature Communications.
Disease Risks Jump
The researchers used data from the US Department of Veterans Affairs national healthcare databases to identify 154,068 people with confirmed COVID-19 from March 1, 2020, through January 15, 2021. They used statistical modeling to compare those patients with 5.6 million patients with similar characteristics who had not been infected during the same period and an historical control group of 5.9 million patients from March 1, 2018, to December 31, 2019, before the virus began to spread across the globe.
The study included hospitalized and nonhospitalized COVID patients. The majority of the study population was male, but the study included almost 1.2 million female patients.
Compared with control persons, post-COVID patients’ increased risk of a GI diagnosis and the excess disease burden at 1 year, respectively, were as follows:
- 102% for cholangitis; 0.22 per 1000 persons
- 62% for peptic ulcer disease; 1.57 per 1000 persons
- 54% for irritable bowel syndrome (IBS); 0.44 per 1000 persons
- 47% for acute gastritis; 0.47 per 1000 persons
- 46% for acute pancreatitis; 0.6 per 1000 persons
- 36% for functional dyspepsia; 0.63 per 1000 persons
- 35% for gastroesophageal reflux disease; 15.5 per 1000 persons
Patients who’d had the virus also were at higher risk for GI symptoms than their COVID-free peers. Their risk was 60% higher for constipation, 58% for diarrhea, 52% for vomiting, 46% for bloating, and 44% for abdominal pain, the investigators found.
The risk of developing GI symptoms increased with COVID-19 severity and was highest for those who received intensive care because of the virus, the researchers note.
Subgroup analyses found that the risks of composite gastrointestinal outcome were evident in all subgroups based on age, race, sex, obesity, smoking, cardiovascular disease, chronic kidney disease, diabetes, hyperlipidemia, and hypertension, the authors write.
Disease Burden Rises
The increased numbers of GI patients with prior SARS-CoV-2 infection are altering the burden on the healthcare system, senior author Ziyad Al-Aly, MD, a clinical epidemiologist at Washington University in St. Louis, Missouri, told Medscape Medical News.
The shift may be pronounced in primary care, where GI concerns should be seen as a trigger for questions about prior SARS-CoV-2 infection, Al-Aly said.
Patients may encounter longer wait times at GI clinics or may give up on trying to schedule appointments if waits become too long, he said. They may also present to emergency departments if they can’t get an outpatient appointment, he added.
Simon C. Mathews, MD, assistant professor of medicine, Division of Gastroenterology, Johns Hopkins Medicine, in Baltimore, Maryland, told Medscape Medical News that he’s seeing increased wait times since COVID emerged.
“We know that the pandemic impacted patients’ ability and willingness to seek GI care. There continues to be a long backlog for patients who are only now getting reconnected to care. As a result, our clinics are busier than ever, and our wait times for appointments are unfortunately longer than we would like,” said Mathews, who was not involved in the research.
Abdominal pain, bloating, diarrhea, and constipation continue to be among the most common symptoms Mathews sees in clinic, he said.
Kyle Staller, MD, a Massachusetts General Brigham gastroenterologist, told Medscape Medical News that it’s important to distinguish symptoms from eventual diagnoses, which lag behind.
“Are patients attributing their symptoms to COVID, or is COVID itself creating a background of inflammation or changes in the nerves that are making these symptoms more common? My suspicion is a little bit of both,” said Staller, who is director of the Gastrointestinal Motility Laboratory at Mass General, Boston.
Although his clinic is seeing patients with the GI signs and symptoms listed in the article, “we’re not seeing as much of some of the diagnoses, like peptic ulcer disease and pancreatitis,” he said. “I wonder if those may be related to some of the consequences of being critically ill in general, rather than COVID specifically. Those diagnoses I would be more skeptical about.”
Duration of Symptoms Unclear
It’s hard to tell patients how long their GI symptoms might last after COVID, given the relatively short time researchers have had to study the virus, said Staller, who was not involved in the research.
The symptoms he’s seeing in patients after COVID mimic those of postinfectious IBS, which literature says could last for months or years, Staller said. “But they should improve over time,” he added.
Senior author Al-Aly agreed that the duration of post-COVID GI symptoms is unclear.
“What I can tell you is that even people who got SARS-CoV-2 infection from March 2020 are still coming back for GI problems,” he said.
Unlike other symptoms of long COVID, such as brain fog, gastroenterologists fortunately know how to treat the GI disorders that evolve from SARS-CoV-2 infection, said Al-Aly, who has studied the long-term effects of the virus on the brain, kidneys, heart, and other organs.
All healthcare providers “need to be thinking about COVID as a risk factor for all these diseases” and should ask patients about SARS-CoV-2 infection when they take their histories, he said.