Does COVID-19 increase the risk of future gastrointestinal problems?

The rapid emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to the coronavirus disease 2019 (COVID-19) pandemic. Several symptoms have been reported following COVID-19 infection, including those that affect the gastrointestinal system.

In a recent study published in virus, Scientists are reviewing existing literature to investigate the association between acute SARS-CoV-2 infection and the incidence of gastrointestinal symptoms.

Approximately 50% of people with irritable bowel syndrome (IBS) have co-occurring mental health conditions, primarily anxiety, that affect their daily lives. Similarly, some patients experience low mood, depression, and anxiety as a post-COVID-19 syndrome. The current review also discusses the burden of physical and mental illness associated with both post-COVID-19 syndrome and gastrointestinal illness.

study: A systematic review of the prevalence of persistent gastrointestinal symptoms and incidence of new gastrointestinal disease after acute SARS-CoV-2 infection. Image credit: SHISANUPONG1986 / Shutterstock.com

How does SARS-CoV-2 affect the digestive system?

Several studies have reported post-coronavirus syndrome, or long coronavirus, which persists for more than 12 weeks after the onset of infection. Based on self-reported data in the UK, around 3.3% of the general population developed long-term coronavirus as of January 2023.

A variety of gastrointestinal symptoms, including diarrhea, dysgeusia, anorexia, nausea, and hematemesis, are frequently reported in patients infected with SARS-CoV-2. In particular, taste disturbance and diarrhea are common long-term symptoms of COVID-19 infection.

A wide range of pathophysiological mechanisms have been proposed to explain how SARS-CoV-2 infection affects the gastrointestinal system. SARS-CoV-2 binds to the angiotensin-converting enzyme 2 (ACE-2) receptor, which is highly expressed in ileal enterocytes located in the small and large intestines. This binding reduces tryptophan absorption and impairs angiotensin homeostasis, which can subsequently lead to inflammation and intestinal bacterial imbalance.

Changes in the gut microbiota have often been observed during acute SARS-CoV-2 infection. More specifically, patients with acute COVID-19 infection have shown a decrease in beneficial gut microorganisms and an increase in opportunistic pathogens in the gastrointestinal tract.

Even after recovery, microbial dysbiosis worsens over time. High levels of interferon beta (IFN-β) and IFN-λ1, as well as persistence of SARS-CoV-2 viral material in the intestinal epithelium, have also been observed following recovery from COVID-19.

About research

All relevant studies related to coronavirus disease 2019 (COVID-19) and gastrointestinal symptoms or diseases published between December 2019 and July 3, 2023 can be found in SCOPUS, OVID MedLine, Europe PubMed Central were obtained from various databases such asPrepublication posted on medRxiv Preprint servers were also included in the analysis.

The current review evaluated all observational studies, including cohort studies, case-control studies, and cross-sectional studies. One of the key inclusion criteria is that patients included in these studies must be experiencing ongoing gastrointestinal symptoms or new gastrointestinal illness beyond acute COVID-19 infection.

research result

After removing duplicate articles, the initial search found a total of 2,549 studies, of which 45 met all inclusion criteria and were considered in the review. Collectively, these studies included 2,224,790 patients with persistent gastrointestinal symptoms after SARS-CoV-2 infection.

The study, conducted in 28 countries around the world, reported the prevalence of gastrointestinal symptoms lasting up to 18 months after recovery from COVID-19. After infection, a higher incidence of gastrointestinal disease associated with dysmotility, functional impairment, autoimmune-mediated diseases, and liver problems was observed.

A high rate of heterogeneity between studies was observed due to data obtained from a variety of settings with varying circumstances. Many studies have shown that a significant number of people may be susceptible to persistent gastrointestinal symptoms after infection with COVID-19. We observed a higher prevalence of diarrhea, nausea, vomiting, and abdominal pain in patients previously infected with SARS-CoV-2 compared to controls.

COVID-19 symptoms varied based on SARS-CoV-2 variants and individuals’ health care-seeking behavior. One study reported that a child with a history of SARS-CoV-2 infection presented to a hospital emergency department with abdominal pain.

We also found that the incidence of IBS increased between 3 and 6 months after COVID-19 infection. However, one study disagreed with this finding, saying that children with a history of COVID-19 infection were prevented from developing persistent diarrhea and nausea in the first month after infection.

A limited number of studies have reported an association between COVID-19 infection and the development of autoimmune-mediated gastrointestinal diseases. This discovery is based on the molecular mimicry hypothesis.Of note is the similar incidence clostridium difficile Infection was observed between patients exposed to SARS-CoV-2 and unexposed patients.

There is no evidence regarding the rate of hospitalization for gastrointestinal infections due to previous SARS-CoV-2 infection in older adults. Therefore, implementation of non-pharmaceutical interventions (NPIs) to limit SARS-CoV-2 transmission may have also reduced enteric infections.

In some cases, oral or intravenous antibiotic treatment has caused persistent diarrhea or difficulty swallowing. This treatment was confirmed to be a strong predictor of gastrointestinal disorders after COVID-19 infection.

Limited studies have reported the incidence of depression in patients with persistent gastrointestinal symptoms after COVID-19 infection. However, there is no strong evidence linking persistent gastrointestinal symptoms to anxiety, low mood, or sleep disturbances.

conclusion

Several studies have shown that post-infectious functional gastrointestinal symptoms are prevalent by 18 months after recovery from coronavirus disease (COVID-19). The study found that compared to the general population, people with a history of COVID-19 infection had an increased incidence of gastrointestinal diseases, including irritable bowel syndrome, liver disease, dyspepsia, and autoimmune-mediated diseases. It turned out to be high.