Surviving Covid-19 can significantly increase your risk of developing chronic symptoms and conditions of the gastrointestinal tract—from constipation and diarrhea to chronic acid reflux, pancreatitis, and inflammation of the bile ducts. A study published this week in Nature Communications.
The study confirms what many long-term Covid patients already know well. But this is one of the largest and most comprehensive analyzes to estimate relative and absolute risks, using medical records from more than 11,652,484 people in Department of Veterans Affairs databases.
The study was led by Ziad Al-Ali, a clinical epidemiologist at the VA St. Louis Health Care System in St. Louis. Along with colleagues, Al-Ali analyzed the medical records of 154,000 people with Covid-19 from March 2020 to January 2021. The researchers then compared the rates of gastrointestinal problems in people with Covid-19 to the rates seen in two controls in the year after infection. partners. One is a contemporaneous cohort of more than 5.6 million people who went from March 2020 to January 2021 without any evidence of Covid-19 infection. The other was among 5.8 million people monitored a year before the pandemic, which served as a control for unreported COVID-19 cases in the contemporaneous cohort.
For a range of previously identified gastrointestinal conditions and symptoms, the researchers found increased relative risks and absolute risk, in terms of excess burden of disease per 1,000 people. Compared to control groups, the Covid-19 survivors had more constipation, diarrhea, abdominal pain, vomiting and bloating a year after infection.
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Survivors had a 35 percent higher risk than controls of developing GERD (gastroesophageal reflux disease), with an increase of 15.5 cases per 1,000 compared with control groups. The risk of inflammation of the bile ducts (cholangitis) doubled, but was still rare, with only 0.22 cases of overload. Survivors had a 62 percent higher risk of peptic ulcer disease, a 54 percent higher risk of irritable bowel syndrome, with an excess burden of 1.57 cases and an excess burden of 0.44 cases. Overall, Covid survivors had a 37 percent higher risk of developing any gastrointestinal condition, with an excess burden of 17.37 cases.
The researchers didn’t look at underlying health conditions that might be linked to those higher risks, but they noted that the more severe a patient’s case of COVID, the greater the risk of long-term gastrointestinal problems. In other words, those who were in the intensive care unit with COVID had the highest risks, followed by those who were hospitalized, and then those who were not hospitalized. Non-hospitalized subjects were at even greater risk for the range of conditions assessed compared to controls.
As with other forms of prolonged covid, which can wreak havoc on many parts and systems of the body, it is not clear how the virus leads to gastrointestinal problems a year after infection. Researchers hypothesize that the virus may persist in some select areas of the body. Disruption of the gut microbiota, tissue injury, autoimmune mechanisms, or chronic inflammation may occur. Some immunological studies have suggested that long-term Covid sufferers may experience a dangerous combination of persistent SARS-CoV-2 antigen, herpesviruses (such as Epstein-Barr that cause mono), and reactivation of chronic inflammation. But for now, researchers don’t fully understand this condition.
It’s also unclear who is at risk of developing long-term problems after COVID-19. Although studies show that the vaccine may reduce the risk of long-term COVID, it does not appear to completely eliminate the risk, nor does prior infection. Also, a person’s risk may change over time since their last vaccination/infection and with different SARS-CoV-2 variants. In the current study, the time period of the examined Covid cases was mostly before the widespread distribution of vaccines, making it impossible for the researchers to assess the effects of the vaccine on risks.
“The overall evidence base reinforces the need for continued emphasis on primary prevention of SARS-CoV-2 infection (and prevention of reinfection) as the foundation of the public health response,” Al-Ali and his colleagues concluded. “Coupled with the evidence accumulated so far on the extent and breadth of organ dysfunction in long-term covid, the findings of this report call for an urgent need to develop strategies to prevent and treat post-acute sequelae of SARS-CoV-2 infection. .”
