Prolonged Gastrointestinal Manifestations After Recovery From COVID-19.

COVID-19 Disorder of Gut-Brain Interaction Irritable Bowel Syndrome Long COVID

Journal

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
ISSN: 1542-7714
Titre abrégé: Clin Gastroenterol Hepatol
Pays: United States
ID NLM: 101160775

Informations de publication

Date de publication:
22 Nov 2023
Historique:
received: 05 08 2023
revised: 15 10 2023
accepted: 07 11 2023
pubmed: 24 11 2023
medline: 24 11 2023
entrez: 23 11 2023
Statut: aheadofprint

Résumé

Acute enteric infections are well known to result in long-term gastrointestinal (GI) disorders. Although COVID-19 is principally a respiratory illness, it demonstrates significant GI tropism, possibly predisposing to prolonged gut manifestations. We aimed to examine the long-term GI impact of hospitalization with COVID-19. Nested within a large-scale observational cohort study of patients hospitalized with COVID-19 across North America, we performed a follow-up survey of 530 survivors 12-18 months later to assess for persistent GI symptoms and their severity, and for the development of disorders of gut-brain interaction (DGBIs). Eligible patients were identified at the study site level and surveyed electronically. The survey instrument included the Rome IV Diagnostic Questionnaire for DGBI, a rating scale of 24 COVID-related symptoms, the Gastrointestinal Symptoms Rating Scale, and the Impact of Events-Revised trauma symptom questionnaire (a measure of posttraumatic stress associated with the illness experience). A regression analysis was performed to explore the factors associated with GI symptom severity at follow-up. Of the 530 invited patients, 116 responded (52.6% females; mean age, 55.2 years), and 73 of those (60.3%) met criteria for 1 or more Rome IV DGBI at follow-up, higher than the prevalence in the US general population (P < .0001). Among patients who experienced COVID-related GI symptoms during the index hospitalization (abdominal pain, nausea, vomiting, or diarrhea), 42.1% retained at least 1 of these symptoms at follow-up; in comparison, 89.8% of respondents retained any (GI or non-GI) COVID-related symptom. The number of moderate or severe GI symptoms experienced during the initial COVID-19 illness by self-report correlated with the development of DGBI and severity of GI symptoms at follow-up. Posttraumatic stress disorder (Impact of Events-Revised score ≥33) related to the COVID-19 illness experience was identified in 41.4% of respondents and those individuals had higher DGBI prevalence and GI symptom severity. Regression analysis revealed that higher psychological trauma score (Impact of Events-Revised) was the strongest predictor of GI symptom severity at follow-up. In this follow-up survey of patients 12-18 months after hospitalization with COVID-19, there was a high prevalence of DGBIs and persistent GI symptoms. Prolonged GI manifestations were associated with the severity of GI symptoms during hospitalization and with the degree of psychological trauma related to the illness experience.

Sections du résumé

BACKGROUND & AIMS OBJECTIVE
Acute enteric infections are well known to result in long-term gastrointestinal (GI) disorders. Although COVID-19 is principally a respiratory illness, it demonstrates significant GI tropism, possibly predisposing to prolonged gut manifestations. We aimed to examine the long-term GI impact of hospitalization with COVID-19.
METHODS METHODS
Nested within a large-scale observational cohort study of patients hospitalized with COVID-19 across North America, we performed a follow-up survey of 530 survivors 12-18 months later to assess for persistent GI symptoms and their severity, and for the development of disorders of gut-brain interaction (DGBIs). Eligible patients were identified at the study site level and surveyed electronically. The survey instrument included the Rome IV Diagnostic Questionnaire for DGBI, a rating scale of 24 COVID-related symptoms, the Gastrointestinal Symptoms Rating Scale, and the Impact of Events-Revised trauma symptom questionnaire (a measure of posttraumatic stress associated with the illness experience). A regression analysis was performed to explore the factors associated with GI symptom severity at follow-up.
RESULTS RESULTS
Of the 530 invited patients, 116 responded (52.6% females; mean age, 55.2 years), and 73 of those (60.3%) met criteria for 1 or more Rome IV DGBI at follow-up, higher than the prevalence in the US general population (P < .0001). Among patients who experienced COVID-related GI symptoms during the index hospitalization (abdominal pain, nausea, vomiting, or diarrhea), 42.1% retained at least 1 of these symptoms at follow-up; in comparison, 89.8% of respondents retained any (GI or non-GI) COVID-related symptom. The number of moderate or severe GI symptoms experienced during the initial COVID-19 illness by self-report correlated with the development of DGBI and severity of GI symptoms at follow-up. Posttraumatic stress disorder (Impact of Events-Revised score ≥33) related to the COVID-19 illness experience was identified in 41.4% of respondents and those individuals had higher DGBI prevalence and GI symptom severity. Regression analysis revealed that higher psychological trauma score (Impact of Events-Revised) was the strongest predictor of GI symptom severity at follow-up.
CONCLUSIONS CONCLUSIONS
In this follow-up survey of patients 12-18 months after hospitalization with COVID-19, there was a high prevalence of DGBIs and persistent GI symptoms. Prolonged GI manifestations were associated with the severity of GI symptoms during hospitalization and with the degree of psychological trauma related to the illness experience.

Identifiants

DOI: 10.1016/j.cgh.2023.11.009 PMID: 37995983
pubmed: 37995983
pii: S1542-3565(23)00947-3
doi: 10.1016/j.cgh.2023.11.009
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2023 AGA Institute. Published by Elsevier Inc. All rights reserved.

Auteurs

Badih Joseph Elmunzer (BJ)

Division of Gastroenterology and Hepatology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina. Electronic address: elmunzer@musc.edu.

Olafur S Palsson (OS)

Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina.

Nauzer Forbes (N)

Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.

Ali Zakaria (A)

Division of Gastroenterology, Department of Medicine, Ascension Providence Hospital/Michigan State University-College of Human Medicine, Southfield, Michigan.

Christian Davis (C)

Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.

Andrew Canakis (A)

Section of Gastroenterology, Department of Medicine, Boston University Medical Center, Boston, Massachusetts.

Emad Qayed (E)

Division of Digestive Diseases, Department of Medicine, Grady Memorial Hospital, Atlanta, Georgia.

Benjamin Bick (B)

Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.

Swati Pawa (S)

Division of Gastroenterology, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina.

William M Tierney (WM)

Section of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.

Caroline G McLeod (CG)

Division of Gastroenterology and Hepatology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.

Jason Taylor (J)

Division of Gastroenterology and Hepatology, Department of Medicine, Saint Louis University, St. Louis, Missouri.

Harsh Patel (H)

Department of Gastroenterology, Ochsner Health, New Orleans, Louisiana.

Robin B Mendelsohn (RB)

Gastroenterology, Hepatology and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.

Gokul Bala (G)

Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio.

Ian Sloan (I)

Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.

Ambreen A Merchant (AA)

Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.

Zachary L Smith (ZL)

Division of Gastroenterology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.

Morgan A Sendzischew Shane (MA)

Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida.

Olga C Aroniadis (OC)

Division of Gastroenterology, Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York.

Collins O Ordiah (CO)

Division of Gastroenterology and Hepatology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.

Johannah M Ruddy (JM)

Rome Foundation Research Institute and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Magnus Simren (M)

Rome Foundation Research Institute and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Institute of Medicine, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.

Jan Tack (J)

Rome Foundation Research Institute and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium.

Douglas Drossman (D)

Rome Foundation Research Institute and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Classifications MeSH