Long COVID: Study Shows That Post COVID Individuals Are At An Increased Risk Of Developing Gastrointestinal Disorders!

Long COVID: A new study by researchers from VA Saint Louis Health Care System, Saint Louis -USA and Washington University School of Medicine, Saint Louis-USA led by Dr Ziyad Al-Aly has found that most that people with SARS-CoV-2 infection are at increased risk of gastrointestinal disorders in the post-acute phase of COVID-19. The researchers advised that Post COVID care should involve attention to gastrointestinal health and disease.


 
The COVID-19 pandemic caused by the SARS-CoV-2 virus has affected millions of people worldwide. While the acute phase of the disease primarily affects the respiratory system, there is growing evidence that SARS-CoV-2 can also affect other organ systems, including the gastrointestinal system.
 
The post-acute phase of COVID-19, commonly known as Long COVID, has been recognized as a significant health concern. Long COVID can involve a range of symptoms and conditions that persist for weeks or even months after the acute phase of the disease has resolved. While research has focused on the pulmonary and cardiovascular complications of Long COVID, there is limited information available on the risks and burdens of gastrointestinal disorders.
 
A comprehensive evaluation of the risks and burdens of gastrointestinal disorders in the post-acute phase of COVID-19 is needed to understand the full spectrum of Long Covid.
 
The study team investigated the risks and burdens of gastrointestinal disorders in people with COVID-19.
 
The study used the US Department of Veterans Affairs national health care databases to build a cohort of 154,068 people who survived the first 30 days of COVID-19, as well as two control groups: a contemporary control of 5,638,795 who lived during the same time but had no evidence of SARS-CoV-2 infection, and a historical cohort of 5,859,621 people from the pre-pandemic era. These cohorts were followed longitudinally to estimate the risks and 1-year burdens of a set of pre-specified incident gastrointestinal outcomes in the overall cohort and by care setting of the acute phase of SARS-CoV-2 infection.
The study found that beyond the first 30 days of infection, people with COVID-19 exhibited increased risks and 1-year burdens of incident gastrointestinal disorders spanning several disease categories, including motility disorders, acid-related disorders (dyspepsia, gastroesophageal reflux disease, peptic ulcer disease), functional intestinal disorders, acute pancreatitis, hepatic and biliary disease.
 
The risks were evident in subgroups based on age, race, sex, obesity, smoking, cardiovascular disease, chronic kidney disease, diabetes, hyperlipidemia, and hypertension. The risks were also evident in people who were not hospitalized during the acute phase of COVID-19 and increased in a graded fashion across the severity spectrum of the acute phase of COVID-19 (from non-hospitalized to hospitalized individuals, to those admitted to intensive care). The risks were consistent in comparisons including the COVID-19 vs. the contemporary control group and COVID-19 vs. the historical control group as the referent category.
 
The study also found that those hospitalized with COVID-19 are at increased risk of several gastrointestinal outcomes compared to those hospitalized with seasonal infl uenza.
 
The study findings suggest that gastrointestinal disease is another facet of Long COVID.
 
The risks were evident even in people whose acute disease did not necessitate hospitalization.
 
Although the absolute burdens may appear small, because of the large number of people with SARS-CoV-2 infection, these rates may translate into a large number of affected people.
 
This will have ramifications not only for the personal health of affected individuals but also on health systems, which will have to address the care needs of people with post-acute COVID-19 gastrointestinal disorders.
 
The study 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.

The study findings also call for the urgent need to develop strategies to prevent and treat the post-acute sequelae of SARS-CoV-2 infection.
 
There have been various hypotheses proposed to explain the diverse manifestations of Long Covid, including those affecting the gastrointestinal system. Some of these mechanisms include dysbiosis in the intestinal microbiome, persistence of the virus in immune-privileged sites leading to chronic inflammation and subsequent organ injury, autoimmune mechanisms, and tissue damage during the acute phase resulting in clinical sequelae during the post-acute phase. Other potential mechanisms involve the angiotensin-converting enzyme 2, which is expressed on the brush border of the small intestinal mucosa and other gastrointestinal cell types. Recent evidence suggests that SARS-CoV-2 may have tropism for the liver and other gastrointestinal tissues, with residual viral antigens found in these tissues and ongoing viral replication in the appendix during the post-acute phase.
 
Alterations in gut microbiota have also been observed in individuals with Long COVID.
 
Studies have shown that individuals with Long COVID have elevated levels of humoral responses directed against SARS-CoV-2 and Epstein-Barr virus, as well as elevated cortisol levels, but not autoantibodies to human exoproteome, which suggests that persistent antigen, reactivation of latent herpesviruses, and chronic inflammation may be key mechanisms for Long COVID.
 
A better understanding of the biological mechanisms behind post-acute sequelae is necessary to identify potential interventions for prevention and treatment.
 
The study findings catalog post-acute gastrointestinal sequelae, which may represent de novo disease, acceleration of underlying preclinical disease, or adverse treatment effects of SARS-CoV-2. Regardless of the mechanism, these sequelae are consequences of the infection and may not have occurred or appeared so quickly without an infection with SARS-CoV-2.
 
Overall, this study of 154,068 people who survived the acute phase of COVID-19 shows an increased risk and burden of post-acute gastrointestinal sequelae across various disease categories, including acid disorders and functional intestinal disorders.
 
The study findings were published in the peer reviewed journal: Nature Communications.
https://www.nature.com/articles/s41467-023-36223-7
 
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