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One GI Symptom Stuck Around Months After Severe COVID

— But most symptoms resolved within 3 months, researchers found

MedpageToday
A computer rendered COVID-19 virus on a plate between a knife and fork.

While most gastrointestinal (GI) symptoms resolved for patients hospitalized with COVID-19, inability to gain weight persisted for months, researchers found in a retrospective study.

Half of all patients (50.6%) could not regain weight at 3 months, while 32.4% of patients reported an inability to gain weight 6 months later, reported Arvind J. Trindade, MD, from Long Island Jewish Medical Center in New Hyde Park, New York, and colleagues.

Percentages were higher among patients with malnutrition, with 56.4% of this population unable to gain weight at 6 months, the authors wrote in .

However, gastroenteritis, GI bleeding, and pancreatitis resolved for most patients 3 months after illness, they noted.

"Our study provides reassurance that most individuals with the onset of GI bleeding or gastroenteritis associated with COVID-19 infection will have resolution of these symptoms," Trindade and colleagues stated.

GI symptoms manifest in patients after the SARS-CoV-2 virus binds to the angiotensin-converting enzyme 2 (ACE2) receptor inside epithelial cells of the GI tract, the group explained. These symptoms occur in anywhere from 17.6% to 53% of COVID-19 patients, they said, with prior reports suggesting that 10.1% to 39.7% of patients experience .

Longer-term data on COVID-19 sequelae and its association to malnutrition has been limited, Trindade told ֱ. From his clinical observations, a lot of COVID-19 patients have trouble regaining weight and the reason why has been largely unknown, he added.

The current study represents the largest cohort of COVID-19 with associated GI symptoms, and included 17,462 patients admitted to a dozen New York hospitals from March 2020 to January 2021. The researchers investigated post-COVID-19 GI sequelae at 3 and 6 months after hospitalization.

Trindade's group included adults who tested positive for SARS-CoV-2 via PCR and were hospitalized with GI symptoms, and had 3 months and/or 6 months of outpatient follow-up or were hospitalized a second time. Most had follow-up data assessed at 3 months (88.7%), but that dropped to 56.5% at 6 months. Median age of patients was 66, with 46% being Caucasian. Average length of hospital stay was 9 days. There were 14.1% who required mechanical ventilation and 14.8% were on vasopressors.

Authors reported a total of 18.5% patients had GI symptoms as a result of COVID-19. Among those cases, 22.1% had symptoms and follow-up data, and 24.4% had distinct GI manifestations. Gastroenteritis was the most common initial GI symptom (52.5%), followed by malnutrition (23%) and bleeding (20.4%).

Among the 19 patients who underwent an endoscopy for GI bleeding, 21.1% were found to have gastric and duodenal ulcers, 21.1% had gastritis or duodenitis, and 21% had normal findings.

Trindade and colleagues urged physicians to focus more specifically on COVID-19 patients who experience malnutrition during hospitalization and highlighted the urgency to develop malnutrition screening assessments for COVID-19 patients who recover from an acute infection.

Limitations of this study included the fact that only hospitalized patients were included. Therefore, the findings may not be applicable to non-hospitalized COVID-19 patients with GI symptoms. Data also only came from New York-area facilities, with a lack of follow-up beyond 6 months.

The next steps in his research could possibly look into systemic causes of GI-related symptoms in COVID-19 patients, and investigate why this is happening, said Trindade.

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    Zaina Hamza is a staff writer for ֱ, covering Gastroenterology and Infectious disease. She is based in Chicago.

Disclosures

Trindade disclosed support from Pentax Medical.

Primary Source

Clinical Gastroenterology and Hepatology

Rizvi A, et al "Gastrointestinal sequelae three and six months after hospitalization for coronavirus disease 2019" Clin Gastroenterol Hepatol 2021; DOI: 10.1016/j.cgh.2021.06.046.