Long COVID and Irritable Bowel Syndrome

With about 60% more patients reporting gastrointestinal (GI) symptoms post-SARS-CoV-2 (COVID-19) infection, the role of gastroenterologists intervening in early screening and management of chronic disorders of gut-brain interaction (DGBI) becomes very critical, according to investigators Walter W Chan, MD, and Madhusudan Grover, MD.

They published their findings and recommendations on the effect of long COVID on GI issues in Clinical Gastroenterology and Hepatology.

“Gastrointestinal (GI) symptoms have been reported among patients with acute SARS-CoV-2 infection since the early part of the pandemic, with prevalence of up to 30%–60%,” they wrote.

“An increasingly recognized subset of patients develops postinfection sequelae also described as long COVID or postacute COVID-19 syndrome (PACS). These patients experience myriad neurologic, respiratory, cardiac, psychiatric, and/or GI symptoms that persist for 4 weeks or more from the initial diagnosis of SARS-CoV-2.

The investigators said that out of a study population of 749 survivors, 29% reported at least 1 new chronic GI symptom 6 months after their COVID-19 infection, with heartburn, constipation, diarrhea, and abdominal pain being the most common.

Of the patients with abdominal pain, 39% met Rome IV criteria for irritable bowel syndrome (IBS). Additionally, COVID-19 infection has led to worsening of pre-existing IBS symptoms. It has also contributed to need for hospitalizations for either acute infections or psychiatric diagnoses such as depression and anxiety.

“Intestinal microbial dysbiosis has also been associated with acute SARS-CoV-2 infection and PACS,” the authors added. “Long-term respiratory dysfunction after COVID-19 is associated with altered gut microbiota and persistently elevated lipopolysaccharide-binding protein levels.”

The overall increase in symptoms, medication usage, and use of health care services among patients with DGBI after COVID-19 infection is disturbing, the authors stated. They postulate that a number of factors have contributed to this trend, such as changes in diet, increased sugar or carbohydrate intake, decreased water intake, and reduced physical activity. These observations may foreshadow a continued rise in patients presenting to gastroenterologist offices with IBS or other DGBI symptoms, they wrote.

“Gastroenterologists should be aware that SARS-CoV-2 infection can result in the development of chronic DGBI, such as IBS, or GI symptoms that may be part of a systemic PACS,” Drs Chan and Grover wrote. “In the absence of alarm symptoms, the diagnostic work-up should be limited and follow paradigms for routine PI-IBS or DGBI, as warranted by the presenting symptoms.”

Reference:
Grover M and Chan W. The COVID-19 pandemic and post-infection irritable bowel syndrome: What lies ahead for gastroenterologists. Clin Gastroenterol Hepatol. Published online: August 6, 2022. DOI: https://doi.org/10.1016/j.cgh.2022.05.044