What is the gastrointestinal impact of Long Covid?

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In a recent study published in Nature Communications, researchers assessed gastrointestinal outcomes associated with coronavirus disease 2019 (COVID-19).

Study: Long-term gastrointestinal outcomes of COVID-19. Image Credit: Explode/Shutterstock
Study: Long-term gastrointestinal outcomes of COVID-19. Image Credit: Explode/Shutterstock


Long COVID refers to the constellation of various post-acute diseases. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can result in a wide variety of post-acute sequelae affecting the pulmonary and many extrapulmonary organs, such as the gastrointestinal tract.

Most studies studying the gastrointestinal post-acute sequelae of COVID-19 are limited to hospitalized patients, have a short follow-up period of a few months, and focus on a limited number of gastrointestinal outcomes.

An examination of the risks and costs of gastrointestinal diseases in the post-acute phase of SARS-CoV-2 infection is necessary but has not yet been conducted. Bridging this knowledge gap is crucial for informing COVID-19 post-acute care policies.

About the study

In the present study, researchers estimated the risks and one-year burdens of a predefined set of gastrointestinal outcomes due to COVID-19.

The team built a cohort of SARS-CoV-2-positive patients who survived the initial 30 days post-positive diagnosis. This cohort was compared to a contemporary control cohort as well as to a historical control cohort where comparable cohort selection criteria were applied, such as surviving the initial 30 days of the follow-up.

Veterans who utilized the Veterans Health Administration (VHA) in 2019 and tested positive for COVID-19 between 1 March 2020 and 15 January 2021 were recruited in the COVID-19 cohort. Additionally, two control groups were established, including one contemporary control cohort of people who existed contemporaneously in the same enrollment timespan as those in the COVID-19 cohort and another historical control cohort from a pre-pandemic time-period.

Initial participants in the contemporary control group were veterans who used the VHA in 2019. Individuals surviving until 1 March 2020 and not already a part of the COVID-19 group were recruited into the contemporary control group. To facilitate comparable follow-up distribution among the contemporary and the COVID-19 and contemporary control groups, the beginning of follow-up for participants from the contemporary control group was randomly assigned according to the same distribution for participants who tested COVID-19 positive for the first time in the COVID-19 cohort.


The COVID-19 group included 154,068 individuals, the historical control group included 5,859,621 individuals, and the contemporary control group included 5,638,795 individuals. The median follow-up duration for the COVID-19 group was 408 days, the contemporary control group was 409 days, and the historical control group was 408, 409, and 409 days. The overall follow-up duration was 14,064,985 person-years.

The team assessed the excess and risk burdens of a predetermined set of gastrointestinal outcomes in COVID-19 patients versus the contemporary control cohort. The excess burdens per 1,000 people at one year were computed according to the difference in the incidence rate predicted between the contemporary control cohort and COVID-19 at one year.

Individuals who survived the initial 30 days of infection with COVID-19 had a higher risk of peptic ulcer disease, gastroesophageal reflux disease (GERD), functional dyspepsia, acute pancreatitis, irritable bowel syndrome, cholangitis, and acute gastritis. The burden and risk of a composite of any diagnosis were 17.37 and 1.37, respectively.

Constipation, stomach pain, diarrhea, bloating, and vomiting were among the signs and symptoms noted. The risk and burden of a combination of these symptoms were 1.54 and 24.02, respectively. The COVID-19 group had an elevated risk of gastrointestinal outcomes compared to the current control group.

In comparison to the contemporary control cohort, the burdens and risks of the prespecified gastrointestinal outcomes were clear even among individuals who were not admitted to the hospital during the acute COVID-19 phase and increased progressively from non-hospitalized to hospitalized to intensive care admission.

In studies comparing the entire COVID-19 cohort to the historical control cohort, in subgroup assessment, and in analyses of the acute phase of COVID-19 by care setting, the findings revealed elevated risks and burdens of the predetermined outcomes. COVID-19 was related to an elevated risk of abnormal liver function tests, composite results of any gastrointestinal outcome, and abnormal coagulation studies compared to seasonal influenza.


The study findings demonstrated an elevated burden and risk of post-acute gastrointestinal sequelae, including acid abnormalities, functional intestinal disorders, hepatic and biliary illness, and pancreatic disorders. The risks were clear even among individuals whose acute COVID-19 symptoms did not warrant hospitalization. These findings show that post-acute COVID-19 care methods should consider gastrointestinal health and disease.

Journal reference:
Bhavana Kunkalikar

Written by

Bhavana Kunkalikar

Bhavana Kunkalikar is a medical writer based in Goa, India. Her academic background is in Pharmaceutical sciences and she holds a Bachelor's degree in Pharmacy. Her educational background allowed her to foster an interest in anatomical and physiological sciences. Her college project work based on ‘The manifestations and causes of sickle cell anemia’ formed the stepping stone to a life-long fascination with human pathophysiology.


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