COVID-19 Linked to Long-Term Gastrointestinal Disorders

COVID-19 is associated with a greater incidence of a wide range of long-term gastrointestinal disorders, investigators at Washington University School of Medicine in St. Louis and the Veterans Affairs St. Louis Health Care system found.

The study, published in Nature Communications, reviewed health records of 154,068 patients in the Department of Veterans Affairs databases who tested positive for COVID-19 between March 1, 2020, and Jan. 15, 2021, and included more than 5.6 million contemporary controls and 5.8 million historical controls.

“COVID-19 can lead to long-term GI issues spanning multiple areas of the GI system (liver, pancreas, acid disorders, motility disorders, etc.),” Ziyad Al-Aly, MD, chief of research and development at the VA St. Louis Health Care System and clinical epidemiologist at Washington University in St. Louis, told Contagion. “The risk was evident even in people who had mild disease that did not require hospitalization.”

Disorders included motility disorders, dyspepsia, gastroesophageal reflux disease, peptic ulcer disease, functional intestinal disorders, acute pancreatitis, hepatic and biliary disease. The risk of GI disorders a year after COVID-19 was greater even among people who were not hospitalized with COVID-19 and increased with disease severity.

Overall, those who had COVID-19 had a 36% greater risk of developing GI disorders within a year after infection than those who did not have COVID-19. That includes:

• 62% greater likelihood of developing ulcers in the stomach or small intestine
• 35% greater risk of acid reflux disease
• 46% greater risk of acute pancreatitis
• 54% greater risk of irritable bowel syndrome
• 47% greater risk of inflammation of the stomach lining
• 36% greater risk of upset stomach with unknown cause
• 54% greater risk of constipation, diarrhea, bloating, vomiting and abdominal pain

“It is astonishing how one virus can wreak havoc in so many organ systems (including the GI system),” Al-Aly said.

Al-Aly and colleagues have been studying the long-term effects of COVID-19, with prior research included long-term cardiovascular effects of the disease, along with effects on the brain and kidneys.

The investigators estimated that COVID-19 has contributed to more than 42 million new cases of GI disorders globally, including 6 million in the United States.

“We wanted to understand how to best prevent these GI (and other long-term health consequences of COVID-19) and how to best treat these things,” Al-Aly said. “We are very focused on that at the moment.”

The data encompassed a time period before COVID-19 vaccines were widely distributed and before the emergence of Delta and Omicron variants of the virus. Other research has suggested that vaccination can provide some protection against long-term outcomes of COVID-19.

More research is needed to understand the mechanisms of the long-term effects after COVID-19. Hypotheses include microbiome disturbances, persistence of the virus leading to chronic inflammation and organ injury, autoimmune mechanisms, and tissue injury.

“Taken with all the evidence that has accumulated thus far, the findings in this report call for the urgent need to double down and accelerate our effort to develop strategies to prevent and treat the long-term health effects after COVID-19 infection,” Al-Aly said in a news release.