Long-Term Impact of COVID-19 on Disorders of Gut-Brain Interaction: Incidence, Symptom Burden, and Psychological Comorbidities

Abstract

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has highlighted the potential exacerbation of gastrointestinal symptoms in patients with disorders of gut-brain interaction (DGBIs). However, the distinct symptom trajectories and psychological burden in patients with post-COVID-19 DGBIs compared with patients with pre-existing irritable bowel syndrome (IBS)/functional dyspepsia (FD) and non-DGBI controls remain poorly understood.

Objectives: To examine the long-term gastrointestinal symptom progression and psychological comorbidities in patients with post-COVID-19 DGBI, patients with pre-existing IBS/FD and non-DGBI controls.

Methods: This post hoc analysis of a prospective multicenter cohort study reviewed patient charts for demographic data and medical history. Participants completed the Gastrointestinal Symptom Rating Scale at four time points: baseline, 1, 6, and 12 months, and the Hospital Anxiety and Depression Scale at 6 and 12 months. The cohort was divided into three groups: (1) post-COVID-19 DGBIs (2) non-DGBI, and (3) pre-existing IBS/FD, with the post-COVID-19 DGBIs group compared to the latter two control groups.

Results: Among 599 eligible patients, 27 (4.5%) were identified as post-COVID-19 DGBI. This group experienced worsening abdominal pain, hunger pain, heartburn, and acid regurgitation, unlike symptom improvement or stability in non-DGBI controls (p < 0.001 for all symptoms, except hunger pain, p = 0.001). While patients with pre-existing IBS/FD improved in most gastrointestinal symptoms but worsened in constipation and incomplete evacuation, patients with post-COVID-19 DGBI exhibited consistent symptom deterioration across multiple gastrointestinal domains. Anxiety and depression remained unchanged in patients with post-COVID-19 DGBI, contrasting with significant reductions in controls (non-DGBI: p = 0.003 and p = 0.057; pre-existing IBS/FD: p = 0.019 and p = 0.007, respectively).

Conclusions: COVID-19 infection is associated with the development of newly diagnosed DGBIs and distinct symptom trajectories when compared with patients with pre-existing IBS/FD. Patients with post-COVID-19 DGBI experience progressive gastrointestinal symptom deterioration and persistent psychological distress, underscoring the need for tailored management strategies for this unique subgroup.

Keywords: COVID‐19; anxiety; depression; disorders of gut‐brain interaction; functional dyspepsia; gastrointestinal symptoms; irritable bowel syndrome; post‐infection gastrointestinal disorders.

FIGURE 1

Flowchart of the selection of patients enrolled in the study.

FIGURE 2

Fluctuation over time of GI symptoms complained by patients with post‐COVID‐19 DGBIs and non‐DGBIs controls, as evaluated using the GSRS questionnaire. The GSRS assesses 15 GI symptoms rated on a 1–7 severity scale, where “1” indicates “no discomfort at all,” “2” corresponds to “very mild,” “3” to “mild,” “4” to “moderate,” “5” to “moderate‐severe,” “6” to “severe,” and “7” to “very severe.” (2A) Fluctuation over time of abdominal symptoms. (2B) Fluctuation over time of upper gastrointestinal symptoms. (2C) Fluctuation over time of lower gastrointestinal symptoms.

FIGURE 2

Fluctuation over time of GI symptoms complained by patients with post‐COVID‐19 DGBIs and non‐DGBIs controls, as evaluated using the GSRS questionnaire. The GSRS assesses 15 GI symptoms rated on a 1–7 severity scale, where “1” indicates “no discomfort at all,” “2” corresponds to “very mild,” “3” to “mild,” “4” to “moderate,” “5” to “moderate‐severe,” “6” to “severe,” and “7” to “very severe.” (2A) Fluctuation over time of abdominal symptoms. (2B) Fluctuation over time of upper gastrointestinal symptoms. (2C) Fluctuation over time of lower gastrointestinal symptoms.

FIGURE 2

Fluctuation over time of GI symptoms complained by patients with post‐COVID‐19 DGBIs and non‐DGBIs controls, as evaluated using the GSRS questionnaire. The GSRS assesses 15 GI symptoms rated on a 1–7 severity scale, where “1” indicates “no discomfort at all,” “2” corresponds to “very mild,” “3” to “mild,” “4” to “moderate,” “5” to “moderate‐severe,” “6” to “severe,” and “7” to “very severe.” (2A) Fluctuation over time of abdominal symptoms. (2B) Fluctuation over time of upper gastrointestinal symptoms. (2C) Fluctuation over time of lower gastrointestinal symptoms.

FIGURE 3

Fluctuation over time of GI symptoms complained by patients with post‐COVID‐19 DGBIs and pre‐existing IBS/FD controls, as evaluated using the GSRS questionnaire. The GSRS assesses 15 GI symptoms rated on a 1–7 severity scale, where “1” indicates “no discomfort at all,” “2” corresponds to “very mild,” “3” to “mild,” “4” to “moderate,” “5” to “moderate‐severe,” “6” to “severe,” and “7” to “very severe.” (2A) Fluctuation over time of abdominal symptoms. (2B) Fluctuation over time of upper gastrointestinal symptoms. (2C) Fluctuation over time of lower gastrointestinal symptoms.

FIGURE 3

Fluctuation over time of GI symptoms complained by patients with post‐COVID‐19 DGBIs and pre‐existing IBS/FD controls, as evaluated using the GSRS questionnaire. The GSRS assesses 15 GI symptoms rated on a 1–7 severity scale, where “1” indicates “no discomfort at all,” “2” corresponds to “very mild,” “3” to “mild,” “4” to “moderate,” “5” to “moderate‐severe,” “6” to “severe,” and “7” to “very severe.” (2A) Fluctuation over time of abdominal symptoms. (2B) Fluctuation over time of upper gastrointestinal symptoms. (2C) Fluctuation over time of lower gastrointestinal symptoms.

FIGURE 3

Fluctuation over time of GI symptoms complained by patients with post‐COVID‐19 DGBIs and pre‐existing IBS/FD controls, as evaluated using the GSRS questionnaire. The GSRS assesses 15 GI symptoms rated on a 1–7 severity scale, where “1” indicates “no discomfort at all,” “2” corresponds to “very mild,” “3” to “mild,” “4” to “moderate,” “5” to “moderate‐severe,” “6” to “severe,” and “7” to “very severe.” (2A) Fluctuation over time of abdominal symptoms. (2B) Fluctuation over time of upper gastrointestinal symptoms. (2C) Fluctuation over time of lower gastrointestinal symptoms.