In a recent study in Nature Communications, researchers comprehensively evaluated the risks and 1-year burden of GI disorders in the postacute phase of a COVID-19 infection.
Lead author Ziyad Al-Aly, MD, a clinical epidemiologist at Washington University School of Medicine in St. Louis and the Veterans Affairs St. Louis Health Care system, and colleagues conducted numerous studies exploring the impact of post-COVID-19 infection on various organ systems, including the effects on the brain, cardiovascular system, and kidneys.
Dr. Al-Aly and colleagues sought to gain more insight into the long-term GI effects associated with COVID-19 infection. The researchers indicated that several hypotheses have been suggested to explain long-term COVID-19 complications, including GI manifestations that may result from microbiome dysbiosis, the persistence of the virus resulting in chronic inflammation, and autoimmune issues and tissue injury during the acute phase of infection.
The researchers examined an estimated 14 million deidentified medical records in a database maintained by the U.S. Department of Veterans Affairs—the nation’s most extensive integrated healthcare system.
The researchers then generated a controlled data set of 154,068 individuals who had tested positive for COVID-19 from March 1, 2020, through January 15, 2021, and survived the first 30 days after infection.
The researchers employed statistical modeling to compare GI outcomes in the COVID-19 data set with two other groups of individuals not infected with the virus, including a control group of more than 5.6 million individuals who did not have COVID-19 during the same timeframe and a control group of more than 5.8 million individuals from March 1, 2018, to December 31, 2019—well before the start of the pandemic.
The authors indicated that GI disorders were generally 36% more likely to occur in individuals with COVID-19 than those without the virus. These findings pertained to individuals regardless of hospitalization because of COVID-19.
The findings revealed that compared with patients in the control groups, individuals who had COVID-19 were at a 62% augmented risk of developing ulcers in the lining of the stomach or small intestine, a 35% heightened risk of suffering from acid reflux disease, and a 46% augmented risk of experiencing acute pancreatitis.
Comparably, individuals with COVID-19 were 54% more likely to experience digestive symptoms such as constipation, diarrhea, bloating, vomiting, and abdominal pain. Additionally, compared with control groups of individuals who were post-COVID-19 infection, 54% were more likely to suffer from irritable bowel syndrome, 47% were more likely to experience inflammation of the stomach lining, and 36% were more likely to have an upset stomach without an apparent cause.
In conclusion, the authors wrote, “In this study of 154,068 people who survived the acute phase of COVID-19, we show increased risk and burden of post-acute gastrointestinal sequelae spanning several disease categories including acid disorders, functional intestinal disorders, pancreatic disorders, hepatic and biliary disease. The risks were evident even among those whose acute COVID-19 did not necessitate hospitalization. Our findings suggest that post-acute COVID-19 care strategies should include attention to gastrointestinal health and disease.”
The researchers estimated that so far, infections triggered by SARS-CoV-2 have caused more than 6 million new cases of GI disorders in the United States and 42 million new cases globally.
In a press release, Dr. Al-Aly stated, “Gastrointestinal problems were among the first that were reported by the patient community. It is increasingly clear that the GI tract serves as a reservoir for the virus,” adding, “This is no small number. It is crucial to include GI health as an integral part of post-acute COVID care.”
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Published March 31, 2023