Prolonged Gastrointestinal Manifestations After Recovery From COVID-19

Background Acute enteric infections are well known to result in long-term gastrointestinal disorders. While COVID-19 is principally a respiratory illness, it demonstrates significant gastrointestinal tropism, possibly predisposing to prolonged gut manifestations. We aimed to examine the long-term gastrointestinal impact of hospitalization with COVID-19. 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 Disorders of Gut-Brain Interaction, a rating scale of 24 COVID-related symptoms, the Gastrointestinal Symptoms Rating Scale (GSRS), and the Impact of Events-Revised (IES-R) trauma symptom questionnaire (a measure of post-traumatic stress associated with the illness experience). A regression analysis was performed to explore the factors associated with GI symptom severity at follow-up. 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 one or more Rome IV DGBI at follow-up, higher than the prevalence in the US general population (p<0.0001). Among patients who experienced COVID-related GI symptoms during the index hospitalization (abdominal pain, nausea, vomiting, or diarrhea), 42.1% retained at least one 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. Post-traumatic stress disorder (IES-R 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 (IES-R) was the strongest predictor of GI symptom severity at follow-up. 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 gastrointestinal manifestations were associated with the severity of GI symptoms during hospitalization and with the degree of psychological trauma related to the illness experience.