Surviving a bout of COVID-19 can significantly increase your risk of developing a range of long-term gastrointestinal symptoms and conditions—from constipation and diarrhea to chronic acid reflux, pancreatitis, and inflammation of the bile ducts a study published this week in Nature Communications.
The study likely confirms what many long-term COVID patients already know all too well. However, the analysis is among the largest and most comprehensive assessing increases in relative and absolute risks, drawing on medical records from 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 examined medical records from over 154,000 people who contracted COVID-19 between March 2020 and January 2021. The researchers then compared the COVID survivors’ rates of gastrointestinal problems in the year following their infection to the rates observed in two control cohorts. One was a contemporary cohort of over 5.6 million people who walked from March 2020 to January 2021 with no evidence of COVID-19 infection. The other involved 5.8 million people tracked for a year prior to the pandemic, which served as a control for unreported COVID-19 cases in the contemporary cohort.
Researchers found increased relative risks and absolute risks – in terms of excess disease burden per 1,000 people – for a range of pre-identified gastrointestinal disorders and symptoms. Compared to the control groups, COVID-19 survivors had more constipation, diarrhea, abdominal pain, vomiting and bloating in the year after their infection.
load
Survivors also had a 35 percent greater risk than controls of developing GERD (gastroesophageal reflux disease), with an additional burden of 15.5 cases per 1,000 compared to controls. The risk of bile duct inflammation (cholangitis) doubled but was still rare, with an overload of only 0.22 cases. Survivors also had a 62 percent greater risk of peptic ulcer disease with an overload of 1.57 cases and a 54 percent greater risk of irritable bowel syndrome with an overload of 0.44 cases. Overall, COVID survivors had a 37 percent greater risk of developing gastrointestinal disease, with an overload of 17.37 cases.
The researchers did not examine the underlying health conditions that might be associated with these higher risks, but found that the more severe a patient’s COVID case, the greater their risk of long-term gastrointestinal problems. In other words, those who were in ICU with COVID had the highest risks, followed by those who were hospitalized and then those who were not hospitalized. Nonetheless, people who were not hospitalized were still at increased risk for all of the disorders studied compared to controls.
As with other forms of long-lived COVID that can devastate many parts and systems of the body, it is unclear how the viral infection leads to gastrointestinal problems in the year following infection. Researchers have hypothesized that a stubborn virus could be present in a few select areas of the body. There could also be a disruption in the gut microbiome, tissue injury, autoimmune mechanisms, or chronic inflammation. Some immunological studies suggest that people with long COVID may experience a dangerous combination of ongoing immune responses to the persistent SARS-CoV-2 antigen, reactivation of herpesviruses (like Epstein-Barr that 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 post-COVID-19. Although studies have shown that vaccination can reduce the risk of a long COVID, it does not appear to completely eliminate the risk, nor does prior infection. And a person’s risk may change over time since their last vaccination/infection and possibly different SARS-CoV-2 variants. In the current study, the time frame of studied COVID cases largely predated the widespread distribution of vaccines, making it impossible for researchers to estimate the impact of vaccination on risk.
“Overall, the evidence base reinforces the need to maintain the focus on primary prevention of SARS-CoV-2 infection (and prevention of reinfection) as the basis of the public health response,” concluded Al-Aly and his colleagues. “Together with the evidence accumulated to date of the extent and breadth of organ dysfunction in Long COVID, the findings in this report call for an urgent need to develop strategies to prevent and treat the post-acute consequences of SARS-CoV-2 infection.”
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