Stomach pain, constipation, diarrhea, vomiting, bloating — these
are symptoms frequently reported by people with long COVID.
Now a large new study reports that COVID patients were
significantly more likely to experience gastrointestinal problems a year after
infection than people who were not infected.
اضافة اعلان
The study, published in the journal Nature Communications,
compared medical records of 154,068 COVID patients in the Veterans Health
Administration system with about 5.6 million patients of similar age and other
characteristics who had not contracted the coronavirus. COVID patients were 36
percent more likely to have long-term gastrointestinal problems that they did
not have before their infection, with 9,605 of them experiencing issues
affecting the digestive system, intestines, pancreas or liver.
The most common diagnoses were acid-related disorders, like
gastroesophageal reflux disease (known as GERD) and peptic ulcer disease, which
were identified in more than 2,600 patients.
The most common diagnoses were acid-related disorders, like gastroesophageal reflux disease (known as GERD) and peptic ulcer disease, which were identified in more than 2,600 patients.
“There seems to be some dysregulation that points to a major
imbalance in acid production,” said the senior author of the study, Dr Ziyad
Al-Aly, chief of research and development at the VA St. Louis Health Care
System and a clinical public health researcher at Washington University in St.
Louis.
Serious inflammatory illnesses — like acute pancreatitis and
cholangitis, which is inflammation of the bile duct system — affected a much
smaller percentage of patients, but they were nonetheless more common among
those who had COVID than those who did not.
“With all of these disorders, there is an increased odds ratio,
meaning that the people who had COVID and survived for 30 days or longer were
more at risk of each of these categories,” said Dr Saurabh Mehandru, a
professor of gastroenterology at the Icahn School of Medicine at Mount Sinai in
New York who was not involved in the study.
Long COVID patients were also at higher risk of gastrointestinal
symptoms, the most common being constipation, abdominal pain and diarrhea.
The study, like others drawing on the database of veterans,
involves a patient population that is largely white and male with an average
age of about 61. Still, the same patterns were seen among the study’s 37,000
post-COVID Black patients and nearly 17,000 post-COVID female patients, Al-Aly
said.
Serious inflammatory illnesses — like acute pancreatitis and cholangitis, which is inflammation of the bile duct system — affected a much smaller percentage of patients, but they were nonetheless more common among those who had COVID than those who did not.
The patients became infected during the pandemic’s early waves,
testing positive for the coronavirus between March 1, 2020, and January 15,
2021, the overwhelming majority before vaccines were available. Al-Aly and
Mehandru noted that the experience might be different for people infected more
recently. Newer virus variants might have different effects, they said, and
some research suggests that vaccines can reduce the risk of various long COVID
symptoms.
There are several reasons coronavirus infections may fuel
long-term gastrointestinal problems. Mehandru, who has studied some possible
causes, said his team and others had found that a protein the virus attaches to
on some cell surfaces, called the ACE2 receptor, was abundant in the lining of
the small intestine. Those receptors might provide a way for the virus to
directly enter the digestive system, he said. It’s also possible that some
viral fragments remained after infections resolved, keeping patients’ immune
systems activated and generating inflammation-related symptoms.
Another possibility is the “gut-brain connection,” said
Mehandru, explaining that “when we’re stressed, we have intestinal
manifestations.” And, he added, “some of the symptoms could also be because of
a generalized state of being unwell or having illness outside of the
intestines, which could impact how we move our bowels or mean that we feel
bloated or have acid reflux.”
Al-Aly said most long COVID patients had other symptoms besides
gastrointestinal problems, suggesting that the condition was “too complex to
have just one mechanism that explains all of it.”
While some symptoms of long COVID, like fatigue and brain fog, can be intractable for months despite different therapies, many gastrointestinal symptoms are treatable.
The new study did not identify whether certain previous health
conditions, like diabetes or cardiovascular disease, put people at greater risk
of post-COVID gastrointestinal problems. Like many other long COVID studies, it
did find that people whose initial infections were severe enough to warrant
intensive care or other hospitalization were more prone to long-term symptoms.
Still, people with mild initial infections — who make up a majority of COVID
patients — were nonetheless at greater risk than people who were not infected.
Underscoring the significance of post-COVID symptoms, the study
found that long COVID patients were at greater risk of gastrointestinal problems
than nearly 6 million people in the veterans database before the pandemic. It
also found that people hospitalized with a coronavirus infection were more
likely to develop long-term gastrointestinal issues than people hospitalized
with the flu.
Al-Aly did sound one note of optimism. While some symptoms of
long COVID, like fatigue and brain fog, can be intractable for months despite
different therapies, many gastrointestinal symptoms are treatable.
“Obviously, there’s no one treatment for all of this,” he said.
“But I think these are diagnoses and signs and symptoms that could be managed.”
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