Nature reports on a large American study on gastrointestinal health following Covid infection.
Abstract:
A comprehensive evaluation of the risks and 1-year burdens of gastrointestinal disorders in the post-acute phase of COVID-19 is needed but is not yet available. Here we use the US Department of Veterans Affairs national health care databases to build a cohort of 154,068 people with COVID-19, contemporary controls, and historical controls to estimate the risks and 1-year burdens of a set of pre-specified incident gastrointestinal outcomes. We show that beyond the first 30 days of infection, people with COVID-19 exhibited increased risks and 1-year burdens of incident gastrointestinal disorders spanning several disease categories including motility disorders, acid related disorders (dyspepsia, gastroesophageal reflux disease, peptic ulcer disease), functional intestinal disorders, acute pancreatitis, hepatic and biliary disease.
The risks were evident in people who were not hospitalized during the acute phase of COVID-19 and increased in a graded fashion across the severity spectrum of the acute phase of COVID-19 (non-hospitalized, hospitalized, and admitted to intensive care). The risks were consistent in comparisons including the COVID-19 vs the contemporary control group and COVID-19 vs the historical control group as the referent category.
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. Post-covid care should involve attention to gastrointestinal health and disease. “The constellation of findings suggests that people with SARS-CoV-2 infection are at increased risk of gastrointestinal disorders in the post-acute phase of COVID-19. The risks and burdens are not trivial – suggesting that post-acute covid care strategies should include attention to gastrointestinal disease.
Extracts:
Our findings suggest that gastrointestinal disease is another facet of the multifaceted Long Covid2,13,14. The risks were evident even in people whose acute disease did not necessitate hospitalization. This group represents the majority of people with COVID-19. Although the absolute burdens (expressed per 1000 persons at 1-year) may appear small, because of the large number of people with SARS-CoV-2 infection, these rates may translate into large number of affected people. This will have ramifications not only for the personal health of affected individuals, but also on health systems which will have to address the care needs of people with post-acute COVID-19 gastrointestinal disorders,
Several hypotheses have been proposed to explain the myriad manifestations of Long Covid including gastrointestinal manifestations. These mechanisms include intestinal microbiome dysbiosis, persistence of the virus in immune privileged sites and subsequent chronic inflammation that may provoke organ injury, autoimmune mechanisms, and tissue injury during the acute phase which lead to clinical sequelae in the post-acute phase of the disease. Other putative mechanisms may involve the angiotensin-converting enzyme 2 which is constitutively expressed on the brush border of the small intestinal mucosa and several other gastrointestinal cell types27. An emerging body of evidence suggests SARS-CoV-2 liver and other gastrointestinal tissue SARS-CoV-2 tropism, residual viral antigens in gastrointestinal and hepatic tissues, persistence of the virus in gastrointestinal tract reservoirs, and ongoing viral replication in the appendix in the post-acute phase of the disease and alteration of gut microbiota in people with Long Covid.
Conclusion:
In sum, 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.