COVID survivors at increased risk of long-term gastrointestinal conditions

Surviving a battle of COVID-19 may increase the risk of developing a range of gastrointestinal symptoms and conditions over the long term – from constipation and diarrhea to chronic acid reflux, pancreatitis and inflammation of the bile ducts – according to A study published this week in Nature Communications,

study confirms the possibility that many long term covid patients already know very well. But the analysis is the largest and most comprehensive to evaluate the increase in relative and absolute risks, drawing on the medical records of more than 11,652,484 people in the Department of Veterans Affairs’ database.

The study was led by Ziad Al-Aly, a clinical epidemiologist at the VA St. Louis Health Care System in St. Louis. Along with colleagues, Al-Aly examined the medical records of more than 154,000 people who had COVID-19 between March 2020 and January 2021. The researchers then compared the COVID survivors’ rates of gastrointestinal problems with the rates seen in the two controls after their infection. comrades. One was a contemporary cohort of more than 5.6 million people who went from March 2020 to January 2021 without evidence of any COVID-19 infection. The others were among 5.8 million people who were tracked for a year before the pandemic, serving as controls for unreported COVID-19 cases in the contemporary cohort.

The researchers found relative risk and absolute risk for a range of pre-diagnosed gastrointestinal conditions and symptoms as an additional burden of disease per 1,000 people. Compared to control groups, COVID-19 survivors had more constipation, diarrhea, abdominal pain, vomiting, and bloating in the year following their infection.

Burden

Survivors had a 35 percent higher risk than controls of developing GERD (gastroesophageal reflux disease), with an additional burden of 15.5 cases per 1,000 compared to control groups. The risk of inflammation of the bile ducts (cholangitis) doubled but was still rare, with an excess burden of only 0.22 cases. Survivors had a 62 percent higher risk of peptic ulcer disease, with an additional burden of 1.57 cases, and a 54 percent higher risk of irritable bowel syndrome, with an additional burden of 0.44 cases. Overall, COVID survivors had a 37 percent higher risk of developing any gastrointestinal condition, with an additional burden of 17.37 cases.

The researchers did not look at underlying health conditions that may be linked to those higher risks, but they noted that the more severe a patient’s COVID case, the higher the risk of long-term gastrointestinal problems. In other words, people who were in the intensive care unit with COVID had the highest risk, followed by those who were hospitalized, and then those who were not hospitalized. That said, those who were not hospitalized still showed increased risk across the range of conditions assessed compared to controls.

Like other forms of long-lasting COVID, which can wreak havoc on multiple parts and systems of the body, it is unclear how the viral infection leads to gastrointestinal problems in the year following infection. Researchers hypothesize that there may be persistent virus in select areas of the body. There may also be disruption of the gut microbiome, tissue injury, autoimmune mechanisms, or chronic inflammation. Some immunology studies have suggested that people with prolonged COVID experience a dangerous combination of persistent immune responses to SARS-CoV-2 antigens, reactivation of herpesviruses (such as Epstein-Barr, which causes mono), and chronic inflammation. can experience. But for now, researchers don’t have a complete understanding of the condition.

It is also unclear who is at risk of developing long-term problems after COVID-19. Although studies have shown Vaccination may reduce risk of prolonged COVIDHowever, it does not appear to completely eliminate risk, nor does prior infection. And a person’s risk may change over time since their last vaccination/infection and potentially with different SARS-CoV-2 variants. In the current study, the time frame of the COVID cases tested was largely before the widespread distribution of vaccines, making it impossible for researchers to assess the effects of vaccination on exposures.

Al-Aly and colleagues concluded, “Overall the evidence base reinforces the need for continued emphasis on primary prevention of SARS-CoV-2 infection (and prevention of re-infection) as the foundation of the public health response.” ” “Combined with the evidence collected so far on the scale and breadth of organ dysfunction in prolonged COVID, the findings of this report provide valuable information to develop strategies to prevent and treat the acute sequelae following SARS-CoV-2 infection.” Urgent necessity demanded.”