Long-term Gastrointestinal Sequelae Following COVID-19: A Prospective Follow-up Cohort Study

Abstract

Background and AimsCOVID-19 is associated with long-term gastrointestinal sequelae; however, prospective longitudinal data are sparse. We prospectively studied the frequency, spectrum and risk factors of post infection functional gastro-intestinal disorders/disorders of gut-brain interaction (PI-FGID/DGBI) following COVID-19.Methods320 cases with COVID-19 and two control groups: (Group-A) 320 healthy spouses/family controls and (Group B) 280 healthy COVID serology-negative controls were prospectively followed up at 1,3 and 6 months using validated Rome IV criteria to evaluate the frequency of PI-FGID/DGBI.ResultsOf 320 cases, at 1 month, 36 (11.3%) developed FGID symptoms. Persistent symptoms were noted in 27 (8.4%) at 3 months, and in 21 (6.6%) at 6 months. At 3 months, 8 (2.5%) had irritable bowel syndrome, 7 (2.2%) had functional diarrhea, 6 (1.9%) had functional dyspepsia, 3 (0.9%) had functional constipation, 2 (0.6%) had FD-IBS overlap, and 1 (0.3%) had functional abdominal bloating/distension. Among symptomatic individuals at 3 months, 8 (29.6%) were positive for isolated carbohydrate malabsorption, 1 (3.7%) was positive for post infection malabsorption syndrome (PI-MAS) and 1 (3.7%) was positive for Intestinal methanogen overgrowth (IMO). None of the healthy controls developed FGID up to 6 months of follow up (p<0.01). Predictive factors at 3 and 6 months were severity of infection (p<0.01) and presence of GI symptoms at the time of infection (p<0.01).ConclusionCOVID-19 led to significantly higher number of new onset PI-FGID/DGBI compared to healthy controls at 3 and 6 months of follow-up. If further investigated some patients can be diagnosed with underlying malabsorption.