Post-infection functional gastrointestinal disorders following coronavirus disease-19: A case-control study

Abstract

Background and aim: Because acute infectious gastroenteritis may cause post-infection irritable bowel syndrome and functional dyspepsia and the severe acute respiratory syndrome coronavirus-2 affects gastrointestinal (GI) tract, coronavirus disease-19 (COVID-19) may cause post-infection-functional GI disorders (FGIDs). We prospectively studied the frequency and spectrum of post-infection-FGIDs among COVID-19 and historical healthy controls and the risk factors for its development.

Methods: Two hundred eighty patients with COVID-19 and 264 historical healthy controls were followed up at 1 and 3 months using translated validated Rome Questionnaires for the development of chronic bowel dysfunction (CBD), dyspeptic symptoms, and their overlap and at 6-month for IBS, uninvestigated dyspepsia (UD) and their overlap. Psychological comorbidity was studied using Rome III Psychosocial Alarm Questionnaire.

Results: At 1 and 3 months, 16 (5.7%), 16 (5.7%), 11 (3.9%), and 24 (8.6%), 6 (2.1%), 9 (3.2%) of COVID-19 patients developed CBD, dyspeptic symptoms, and their overlap, respectively; among healthy controls, none developed dyspeptic symptoms and one developed CBD at 3 months (P < 0.05). At 6 months, 15 (5.3%), 6 (2.1%), and 5 (1.8%) of the 280 COVID-19 patients developed IBS, UD, and IBS-UD overlap, respectively, and one healthy control developed IBS at 6 months (P < 0.05 for all except IBS-UD overlap). The risk factors for post-COVID-19 FGIDs at 6 months included symptoms (particularly GI), anosmia, ageusia, and presence of CBD, dyspeptic symptoms, or their overlap at 1 and 3 months and the psychological comorbidity.

Conclusions: This is the first study showing COVID-19 led to post-COVID-19 FGIDs. Post-COVID-19 FGIDs may pose a significant economic, social, and healthcare burden to the world.

Keywords: Beta coronavirus; COVID-19; Functional dyspepsia; Gastrointestinal symptoms; Gut-brain axis disorders; Irritable bowel syndrome; Post-infection IBS.

Figure 1

Venn diagrams showing chronic bowel dysfunction (CBD), dyspeptic symptoms, and their overlap at 1 and 3 months and irritable bowel syndrome (IBS), uninvestigated dyspepsia (UD) and their overlap at 6 months follow‐up in patients with coronavirus disease‐19 (COVID‐19). , CBD; , Dyspeptic symptoms; , Overlap; , IBS; , UD; , IBS‐UD overlap.

Figure 2

Kaplan–Meier curves showing the development of (a) chronic bowel dysfunction (CBD), (b) dyspeptic symptoms, and (c) their overlap and (d) irritable bowel syndrome (IBS), (e) uninvestigated dyspepsia (UD), and (f) their overlap during six month follow‐up among patients with coronavirus disease‐19 (COVID‐19) as compared with healthy controls. , Case; , Control.

Figure 3

Kaplan–Meier curves showing the development of functional gastrointestinal disorders (e.g. irritable bowel syndrome [IBS], uninvestigated dyspepsia [UD], and their overlap) at 6 month follow‐up (a) among symptomatic as compared to the asymptomatic patients with coronavirus disease‐19 (COVID‐19), and (b) among those with and without gastrointestinal (GI) symptoms. (a) , Asymptomatic; , Symptomatic. (b) , No GI symptoms; , GI symptoms +.

Figure 4

Balloon plots showing that some of the psychological factors (as per Rome III Psychosocial Alarm Questionnaire) initially and during follow‐up were associated with the development functional gastrointestinal disorders (FGIDs) among the patients with coronavirus disease‐19 (COVID‐19). CBD, chronic bowel dysfunction; IBS, irritable bowel syndrome; UD, uninvestigated dyspepsia. Figures in row (a) present data on anxiety questions, row (b) depression questions, and row (c) body pain questions at 1, 3, and 6 months, respectively. For P values, refer to Table 3. (a) , 150; , 100; , 50; , 0; . (b) , 150; , 100; , 50; , 0; . (c) , 150; , 100; , 50; , 0; .