Surviving an episode of COVID-19 can significantly increase the risk of developing a range of long-term gastrointestinal symptoms and conditions – from constipation and diarrhea to chronic acid reflux, pancreatitis and inflammation. bile ducts – according to a study published this week in Nature Communications.
The study likely confirms what many long-time COVID patients already know all too well. But the analysis is among the largest and most comprehensive in assessing increased relative and absolute risk, drawing on the medical records of more than 11,652,484 people in the Department of Veterans Affairs databases.
The study was led by clinical epidemiologist Ziyad Al-Aly of the VA Saint Louis Health Care System in Saint Louis. Along with colleagues, Al-Aly reviewed the medical records of more than 154,000 people with COVID-19 between March 2020 and January 2021. The researchers then compared the rates of gastrointestinal problems among COVID survivors over the course of the the year following their infection at the rates observed in two control cases. cohorts. One was a contemporary cohort of over 5.6 million people who passed from March 2020 to January 2021 without any evidence of COVID-19 infection. The other was 5.8 million people who were followed for a year before the pandemic, which served as a control for unreported COVID-19 cases in the contemporary cohort.
The researchers found increased relative risks and absolute risk – in the form of excess disease burden per 1,000 people – for a range of pre-identified gastrointestinal conditions and symptoms. Compared to control groups, COVID-19 survivors had more constipation, diarrhea, abdominal pain, vomiting, and bloating in the year after infection.
Survivors also had a 35% higher risk than controls of developing GERD (gastroesophageal reflux disease), with an additional burden of 15.5 additional cases per 1,000 compared to control groups. The risk of inflammation of the bile ducts (cholangitis) has doubled, but remains rare, with an excess burden of only 0.22 cases. Survivors also had a 62% higher risk of peptic ulcer, with an excess burden of 1.57 cases, and a 54% higher risk of irritable bowel syndrome, with an excess burden of 0.44 cases. In total, COVID survivors had a 37% higher risk of developing gastrointestinal disease, with an additional burden of 17.37 cases.
The researchers did not examine the underlying health conditions that might be linked to these higher risks, but they did note that the more severe a patient’s COVID case, the greater the risk of gastrointestinal problems at long term is high. In other words, those who were in the intensive care unit with COVID had the highest risks, followed by those who were hospitalized, then those who were not hospitalized. That said, people who were not hospitalized still had an increased risk across all assessed conditions compared to controls.
As with other forms of long COVID, which can wreak havoc on many parts and systems of the body, it is unclear how viral infection leads to gastrointestinal problems within a year of infection. The researchers speculated that there might be a lingering virus in certain selected areas of the body. There could also be disruption of the gut microbiome, tissue damage, autoimmune mechanisms, or chronic inflammation. Some immunological studies have suggested that people with long-term COVID may experience a dangerous combination of persistent immune responses to persistent SARS-CoV-2 antigen, reactivation of herpes viruses (such as Epstein-Barr, which causes mono) and chronic inflammation. But right now, researchers don’t have a full understanding of the condition.
It’s also unclear who is at risk of developing long-term problems after COVID-19. Although studies have shown that vaccination can reduce the risk of long COVID, it does not seem to completely eliminate the risk, nor does a previous infection. And a person’s risk can change over time since their last vaccination/infection and, potentially, different variants of SARS-CoV-2. In the current study, the time period of the COVID cases examined largely predated the widespread distribution of vaccines, making it impossible for researchers to assess the effects of vaccination on risk.
“Overall, the evidence base reinforces the need to continue to emphasize primary prevention of SARS-CoV-2 infection (and prevention of reinfection) as the foundation of the health response. public,” Al-Aly and his colleagues concluded. “Weaved together with the evidence accumulated so far on the magnitude and extent of organ dysfunction in long COVID, the findings of this report call for the urgent need to develop strategies to prevent and treat the post-acute sequelae of SARS-CoV-2 infection.”