COVID-19 infection causing residual gastrointestinal symptoms – a single UK centre case series

Abstract

Although COVID-19 was first recognised as an acute respiratory illness, extra-pulmonary manifestations are increasingly being recognised. Acute gastrointestinal side effects have been well reported with COVID-19 infection and are estimated to affect around 17% of patients. With COVID-19 still being a relatively new illness, the chronic gastrointestinal symptoms are less well characterised. Post-infectious irritable bowel syndrome (IBS) can occur following bacterial and viral infections, and with ACE-2 receptors being shown to be present in the gastrointestinal tract and SARS-Cov-2 RNA being present in stool, SARS-CoV-2 is now appreciated as an enteric pathogen. In our study, we survey acute and chronic gastrointestinal symptoms after COVID-19 infection. We have conducted one of the few UK studies on gastrointestinal symptoms, with the longest follow-up duration of 6 months. We have found that gastrointestinal symptoms are common at 6 months, affecting 43.8% of our patients. Further research is needed to explore whether this represents a new post-COVID-19 IBS, which has not previous been described in the literature, including its clinical course and response to any potential medical therapies.

Post‐COVID‐19 irritable bowel syndrome

“…We read with great interest the article by Blackett and colleagues 1 with abdominal pain (29.2%), diarrhea (18.8%), constipation (10.4%), nausea (10.4%), and dyspepsia (29.2%) being the most commonly reported symptoms. 2 Of our responders, 39.1% were troubled by these symptoms every day; which would be compatible with Rome IV IBS diagnostic criteria. 5 A recent Nature review article by Meringer and Mehandru 6 has further supported this phenomenon, as a "post-acute COVID-19 syndrome"; offering an overview of various potential mechanisms for its pathogenesis, including persistent inflammation, autoimmunity, persistence of viral antigen, altered cytokine production, prior mental health condition, maladaptive neuro-immune interactions, and alteration to the fecal microbiome.…”

“…Our prospective survey study examined the long‐term GI effects and showed that 43.8% of responders had new persistent GI symptoms at 6 months following their PCR diagnosis of COVID‐19; with abdominal pain (29.2%), diarrhea (18.8%), constipation (10.4%), nausea (10.4%), and dyspepsia (29.2%) being the most commonly reported symptoms. 2 Of our responders, 39.1% were troubled by these symptoms every day; which would be compatible with Rome IV IBS diagnostic criteria. 5 …”

“…We read with great interest the article by Blackett and colleagues 1 describing new gastrointestinal (GI) symptoms at 6 months following COVID‐19 infection—echoing findings in our own study where we proposed the existence of a novel “post‐COVID‐19 irritable bowel syndrome (IBS).” 2 Beckett et al retrospectively reviewed medical records of 147 patients to identify that 16% reported new GI symptoms at a median follow‐up time of 106 days, and also conducted an online survey of self‐identified survivors of COVID‐19 infection, where 40% responders reported new GI symptoms at 6 months.…”

Irritable bowel syndrome following COVID-19: underestimated consequence of infection with SARS-CoV-2

“…Cooney et al did not analyze their patients with the Rome IV criteria questionnaire, which makes it impossible to refer to and compare with our results. In the conclusions, the authors stated that additional studies are urgently needed to further confirm the hypothesis of IBS after COVID-19 [20].…”

Probiotics in the Management of Mental and Gastrointestinal Post-COVID Symptomes

“…As we previously reported, an impaired gut barrier and microbial alterations may lead or be associated with gastrointestinal [ 54 ], mental [ 137 ], and metabolic [ 138 ] symptoms or disorders. Cooney et al reported that gastrointestinal symptoms were common at 6 months among 43.8% individuals post COVID-19 disease [ 139 ]. Ours, yet unpublished data of a cohort of COVID-19 individuals in Poland, supports previous reports of a high percentage of patients with GI symptoms following COVID-19 recovery.…”