Study Finds Link Between COVID-19 and Elevated Risk of GI Disorders

Patients with COVID-19 may have an elevated risk of developing new gastrointestinal disorders (GIDs) compared with propensity-matched controls, underscoring the need for more research on gastrointestinal (GI) conditions post COVID-19 infection, according to a study.¹

The goal of the retrospective study, published in Scientific Reports, was to determine whether GI symptoms that commonly persist after SARS-CoV-2 infection were leftover symptoms from the infection or if COVID-19 increased the incidence of new GIDs. Additionally, evidence shows that the SARS-CoV-2 virus enters and replicates in epithelial cells in the GI tract, similar to GI manifestations associated with the influenza virus.

The goal of the retrospective study was to determine whether GI symptoms that commonly persist after SARS-CoV-2 infection were leftover symptoms from the infection or if COVID-19 increased the incidence of new GIDs. | Image credit: JOE LORENZ DESIGN - stock.adobe.com

According to the National Institute of Diabetes and Digestive and Kidney Diseases, about 60 million to 70 million people in the US are affected by digestive diseases.² Reported figures for the prevalence of patients diagnosed with COVID-19 who have experienced GI manifestations have varied, ranging from 3% to 79% of patients with confirmed COVID-19.³ GIDs include irritable bowel syndrome (IBS), diverticulitis, gastritis, pancreatitis, peptic ulcers, and inflammatory bowel disease (IBD), an umbrella term for Crohn disease and ulcerative colitis.

“It is unclear whether SARS-CoV-2 infection exerts differential effects on GID post infection in different racial or ethnic subgroups as well as individuals with pre-existing medical conditions. Exploring these associations could provide critical insights into the longer-term GI effects of COVID-19,” wrote the authors of the current study.¹

Researchers assessed data from March 2020 to July 2023 from Montefiore Health System, which consists of several hospitals and outpatient clinics in the Bronx borough of New York, New York, and treats a diverse population. Data on patients with a positive polymerase chain reaction test for COVID-19 were included. Of the more than 1.1 million people treated within the Montefiore health system, 56,745 had positive COVID-19 tests. Of those positive cases, 41,046 did not have a prior history of GI symptoms. Of those 41,046 patients, 35,102 had multiple visits. Additionally, 682,594 patients with negative COVID-19 tests had multiple visits during the same time frame.

In total, 2,228 (6.34%) patients who were COVID-19 positive and 38,928 (5.7%) who were COVID-19 negative had new GI symptoms. Patients with COVID-19 were older on average (41.79 years vs 39.76 years; P < .001), were more likely to be active smokers (14.51% vs 13.13%, P < .001), and exhibited a higher prevalence of major comorbidities (P < .001) compared with patients who were COVID-19 negative. Both groups had a higher proportion of women (56.18% and 55.77%, respectively) and non-Hispanic individuals (59.05% and 65.11%, respectively).

Patients who tested negative for COVID-19 were matched with patients who tested positive for COVID-19 by age, sex, race, and ethnicity using a 1:2 propensity score matching method. A cumulative incidence curve showed that individuals who tested positive for COVID-19 had a higher rate of developing new GIDs compared with those who tested negative, accounting for competing risks like death.

The Cox proportional hazard model revealed that individuals who tested positive for COVID-19 had a 37% higher crude hazard of developing new GI disorders (HR, 1.37; 95% CI, 1.30-1.44). After adjusting for factors such as smoking, diabetes, hypertension, chronic kidney disease, asthma, and obesity, the adjusted HR was 1.18 (95% CI, 1.12-1.25). Similar findings were observed in unmatched data.

An analysis of different COVID-19 viral strains showed the highest incidence of new GI disorders during the Alpha strain period (3.91%) and the lowest during the Delta strain period (2.48%). While incidences of new GIDs were generally comparable across the original, Alpha, Delta, and Omicron strains, the Delta strain had a significantly lower incidence (P < .05).

The study's limitations include potential selection bias, missing or misclassified data, lack of analysis on treatment effects, unrecorded vaccine status, and the inability to control for all confounding factors due to its retrospective nature. The authors noted that the findings stress the need for targeted interventions, particularly for vulnerable populations.

References

1. Changela S, Ashraf S, Lu JY, et al. New-onset gastrointestinal disorders in COVID-19 patients 3.5 years post-infection in the inner-city population in the Bronx. Sci Rep. Published online December 30, 2024. doi:10.1038/s41598-024-83232-7

2. Digestive diseases statistics for the United States. National Institute of Diabetes and Digestive and Kidney Diseases. Updated November 2014. Accessed January 13, 2024. https://www.niddk.nih.gov/health-information/health-statistics/digestive-diseases

3. Groff A, Kavanaugh M, Ramgobin D, et al. Gastrointestinal manifestations of COVID-19: a review of what we know. Ochsner J. 2021;21(2):177-180. doi:10.31486/toj.20.0086