Severe COVID-19 associated with more IBS, less constipation

Patients hospitalized for COVID-19 may be at long-term risk for irritable bowel syndrome (IBS) but at less risk for constipation and hard stools, according to a recent study.

Researchers performed a prospective multicenter controlled study to evaluate the prevalence of GI symptoms and post-COVID-19 disorders of gut-brain interaction after hospitalization for SARS-CoV-2 infection. The study involved 36 centers in 14 countries: Italy, Bangladesh, Cyprus, Egypt, Israel, India, Macedonia, Malaysia, Romania, the Russian Federation, Serbia, Spain, Sweden, and Turkey. Patients with and without a diagnosis of COVID-19 were evaluated at hospital admission and at one, six, and 12 months after discharge. Seven hundred seventy-two patients (548 with COVID-19 and 224 controls) completed follow-up evaluations at six months, and 623 patients (435 with COVID-19 and 188 controls) did so at 12 months. The primary outcomes were GI symptoms, anxiety, and depression as assessed by validated questionnaires. The results were published Dec. 9 by Gut.

The primary analysis included 883 patients, 614 with COVID-19 and 269 controls. Mean age was 49.9 years for those with COVID-19 and 50.9 years for controls, and more than half of patients in each group (59.9% and 62.1%, respectively) were men. GI symptoms, such as nausea and diarrhea, were more common at study enrollment in patients with COVID-19 than in controls (59.3% vs. 39.7%; P<0.001). At 12-month follow-up, controls were significantly more likely than those with COVID-19 to report constipation and hard stools (16% vs. 9.6% [P=0.019] and 17.7% vs. 10.9% [P=0.011], respectively), while patients with COVID-19 reported higher rates of IBS according to Rome IV criteria than controls (3.2% vs. 0.5%; P=0.045). History of allergies, long-term use of proton-pump inhibitors, and dyspnea were significantly associated with IBS diagnosis. Patients with COVID-19 were more likely to fulfill criteria for depression at six-month follow-up than controls.

The researchers noted that their sample size was reduced because they excluded patients with previous GI symptoms and that length of follow-up may have affected prevalence of outcomes, among other limitations. They concluded that hospitalization for COVID-19 is associated with a modest increase in risk for long-term GI symptoms and IBS. “Given the high prevalence of COVID-19 at the global level, an increase in new-onset disorders of gut-brain interaction should be expected due to COVID-19, especially after hospitalisation for this disease,” the authors wrote. “Future studies are needed to improve our understanding of the mechanisms underlying symptom development in these patients, and to identify novel therapeutic strategies to prevent and treat these conditions.”