Study: Chronic GI Disorders Surfaced Months After COVID

Four in 10 COVID-19 patients from disadvantaged communities developed new post-COVID gastrointestinal disorders, including functional dyspepsia (FD) and irritable bowel syndrome (IBS), researchers found in a retrospective study.

In a survey of 200 individuals, 39.5% developed de novo post-COVID gastrointestinal disorders, with 58 reporting FD-like complaints, two reporting IBS-like complaints, and 19 reporting both, according to researchers led by Christopher Vélez, MD, of the Massachusetts General Hospital in Boston, and colleagues.

After adjustment, anxiety and depression (OR 3.27, 95% CI 1.65-6.58) and female sex (OR 2.38, 95% CI 1.20-4.84) were independently associated with incident FD or IBS-like post-COVID gastrointestinal disorders, the authors wrote in Clinical Gastroenterology and Hepatology.

They described the cohort as being a “predominantly medically underserved community,” with 87% from racial/ethnic minority communities, and 97% living in “disadvantaged” zip codes.

Prior research on functional disorders, or disorders of gut-brain interaction, have been limited to hospitalized patients with severe COVID-19 infection, but this cohort aimed to include those with a more “typical illness course” post-infection, the authors explained. A previous study found that improvements in patient psychological factors also led to improvements in functional disorders.

“Our results represent some of the earliest data suggesting that FD- and IBS-like [post-COVID gastrointestinal disorders] are of clinical concern,” they said. “While the provoking event is presumed to be viral infection of the digestive tract, the independent association of sex and anxiety/depression with risk of developing post-COVID GI symptoms is similar to what has been reported in [disorders of gut-brain interaction].”

Vélez and colleagues evaluated ambulatory patients from respiratory illness clinics who were identified as having COVID-19 from April to September 2020. Six months after diagnosis, patients were mailed brochures prior to being screened via phone calls for post-COVID gastrointestinal disorders. A cash raffle incentive was used to encourage participant enrollment. Participants who spoke English or Spanish, who were willing to complete a “protocolized gastrointestinal symptom assessment” at diagnosis, and undergo phone screening were included.

The primary outcome assessed occurrence of “IBS-like” and “FD-like” post-COVID gastrointestinal disorders over 3 and 6 months through a modified ROME IV questionnaire. Patient-reported outcomes assessing gastrointestinal symptoms and psychological stress were secondary outcomes.

“It is anticipated in some that FD- and IBS-like [post-COVID gastrointestinal disorders] will progress to meet formal time-based Rome criteria; our work suggests providers need to be mindful of possible [disorders of gut-brain interaction]-development as post-COVID syndromes,” the researchers wrote.

Patients were an average age of 48, and 63% were female. About 68% of participants were Hispanic. Psychological distress was correlated with the severity of gastrointestinal symptoms for patients with new-onset FD-like (R=0.34) or IBS-like symptoms (R=0.57; P<0.01 for both).

Stress caused by financial factors or fears of COVID-19 illness progression were not associated with the development of post-COVID gastrointestinal disorders, they noted. There was a similar risk of developing these disorders among patients with and without gastrointestinal symptoms at the time of being diagnosed with COVID-19.

The analysis had several limitations, including a small number of participants, the potential for recall and selection bias, and no control group.