New GI Disorders Common After COVID-19 Recovery

Disorders of gut–brain interaction (DGBIs) are based on symptoms (e.g., dyspepsia, abdominal pain and irritable bowel syndrome [IBS]) rather than quantifiable organ pathology. Postinfectious DGBIs are expected to be provoked by the COVID-19 pandemic since the SARS-CoV-2 virus can infect the gastrointestinal (GI) tract and GI symptoms are common during acute infection.

Subscribe to the latest updates from Digestive Health Advances in Motion

Thank you for subscribing!

Error: Please enter a valid email address.

Email Address Submit

Christopher Vélez, MD, a gastroenterologist practicing within the Center for Neurointestinal Health at Massachusetts General Hospital, Kyle Staller, MD, MPH, director of the Gastrointestinal Motility Laboratory in the Division of Gastroenterology, and colleagues determined DGBI-like post–COVID-19 GI disorders are very common in the population the hospital principally serves. They published their findings in Clinical Gastroenterology and Hepatology.

Methods

The team assembled a retrospective cohort for this longitudinal study. Adult patients were eligible if they had been diagnosed with COVID-19 in outpatient respiratory illness clinics at Mass General between April and September 2020, and underwent protocolized GI assessment at that time.

272 patients completed screening interviews conducted in English or Spanish at least six months after COVID-19 diagnosis. They were asked about post–COVID-19 GI symptoms using modified Rome IV questions. Patients were deemed to have a functional dyspepsia (FD)–like disorder if they endorsed any dyspepsia-related question and to have an IBS-like disorder if they endorsed two of three prompts for bowel disturbance.

72 patients were excluded because they reported having dyspeptic or bowel symptoms before their COVID-19 diagnosis. Of the final cohort of 200 patients, 97% were living in a zip code where people earn <100% of a living wage. Individuals from racial/ethnic minority communities represented 87% of the cohort (particularly Latino/a/x people, 68%).

The participants completed questionnaires about symptom severity and psychological stressors, including lost income due to the pandemic, being hospitalized after an ambulatory COVID-19 diagnosis or knowing individuals who died of COVID-19 or became ill enough to require hospitalization.

Results

The key results were that:

• 79 patients (39.5%) reported new-onset GI disorders: 58 had an FD-like disorder, two had an IBS-like disorder, and 19 had both
• Female sex (adjusted OR, 2.38) and a history of depression or anxiety (aOR, 3.27) were independently associated with new-onset FD- and IBS-like disorders; having been hospitalized with COVID-19 was not associated
• Patients who had GI symptoms at the time of COVID-19 diagnosis were as likely to have a post–COVID-19 GI disorder as those who had not experienced GI symptoms
• Psychological distress correlated with GI symptom severity (FD-like disorders: r=0.34, P<0.01; IBS-like disorders: r=0.57, P<0.01)

Continued Scrutiny Needed

This study presents some of the earliest data that FD- and IBS-like post–COVID-19 disorders are common and of clinical concern. Because neuropsychiatric complications can also occur after COVID-19, the association of the GI disorders with anxiety/depression is particularly noteworthy.

It's anticipated that in some patients these FD- and IBS-like disorders will progress to meet formal Rome criteria for FD and IBS.

view original journal article Subscription may be required

Visit the Division of Gastroenterology

Refer a patient to the Division of Gastroenterology