A Systematic Review of the Prevalence of Persistent Gastrointestinal Symptoms and Incidence of New Gastrointestinal Illness after Acute SARS-CoV-2 Infection

Abstract

It is known that SARS-CoV-2 infection can result in gastrointestinal symptoms. For some, these symptoms may persist beyond acute infection, in what is known as 'post-COVID syndrome'. We conducted a systematic review to examine the prevalence of persistent gastrointestinal symptoms and the incidence of new gastrointestinal illnesses following acute SARS-CoV-2 infection. We searched the scientific literature using MedLine, SCOPUS, Europe PubMed Central and medRxiv from December 2019 to July 2023. Two reviewers independently identified 45 eligible articles, which followed participants for various gastrointestinal outcomes after acute SARS-CoV-2 infection. The study quality was assessed using the Joanna Briggs Institute Critical Appraisal Tools. The weighted pooled prevalence for persistent gastrointestinal symptoms of any nature and duration was 10.8% compared with 4.9% in healthy controls. For seven studies at low risk of methodological bias, the symptom prevalence ranged from 0.2% to 24.1%, with a median follow-up time of 18 weeks. We also identified a higher risk for future illnesses such as irritable bowel syndrome, dyspepsia, hepatic and biliary disease, liver disease and autoimmune-mediated illnesses such as inflammatory bowel disease and coeliac disease in historically SARS-CoV-2-exposed individuals. Our review has shown that, from a limited pool of mostly low-quality studies, previous SARS-CoV-2 exposure may be associated with ongoing gastrointestinal symptoms and the development of functional gastrointestinal illness. Furthermore, we show the need for high-quality research to better understand the SARS-CoV-2 association with gastrointestinal illness, particularly as population exposure to enteric infections returns to pre-COVID-19-restriction levels.

Keywords: SARS-CoV-2; diarrhoea; gastrointestinal; irritable bowel syndrome; long-COVID; post-COVID syndrome.

Figure 1

PRISMA flowchart detailing search results.

Figure 2

Time plots showing symptom prevalence against time since acute SARS-CoV-2 infection in adults (A: diarrhoea, B: nausea & vomiting, C: taste & smell disorders, D: abdominal pain). Size of points indicates cohort size. Triangles indicate point prevalence at that exact timepoint, whereas circles indicate studies reporting the lower bound of symptom duration. Colour indicates the study end date by year, whereas black indicates no study end date was specified.

Figure 3

Forest plot showing the association between SARS-CoV-2 exposure and persistent gastrointestinal manifestations. OR = odds ratio. Asterisk (*) denotes studies conducted in children aged <18 years. Studies included: [40,47,51,52,55,56,68].