GUT: What are the long-term effects of the coronavirus on the digestive tract? A follow-up study of up to 12 months showed that the incidence of irritable bowel syndrome in hospitalized patients with the new crown increased by 6 times

*For medical professionals only

If there is anything in the country that can run faster than the new crown virus, it is probably all kinds of rumors about the new crown virus, and the singularity cake feels that it has to break itself into three or four parts to do a good Fact-Check, after all, the things spread by various family groups of friends are getting more and more outrageous day by day, and they are afraid of making any mess regardless of it
.

And as we all know, the more unknown the existence, the easier it is to cause panic, and new mutant strains like XBB.
1.
5 are even more so, just a WeChat chat record of unknown origin a few days ago, which caused countless people to panic about "new crown diarrhea", so that montmorillonite, norfloxacin and even diapers were robbed.
.
.

In recent days, the singularity cakes have also received a lot of related questions in the background, just here to make a unified response: At present, there are not many studies on XBB.
1.
5 in the scientific community, but the existing evidence does not suggest that XBB.
1.
5 is more likely to cause diarrhea, blind panic, follow the trend of rush to buy, can be said to be quite meaningless
.

However, a study published in the well-known journal Gut last month is worth the reference of the "Yangkang" people here: the incidence of irritable bowel syndrome (IBS) in patients with new crown infection who need to be hospitalized will increase significantly, reaching more than 6 times that of the control population (3.
2% vs.
0.
5%)!

Moreover, half of the patients who develop IBS are diarrhea type (IBS-D), so you can make some preparations accordingly after "Yangkang".

It is also worth mentioning that the incidence of constipation and dry stool in new crown patients after discharge is also lower than that of the control population [1], and it seems that the impact of the new crown virus on the digestive tract and even the intestine-brain axis is worth paying attention to
.

Thesis title map

Although the name "new coronavirus pneumonia" has been used for nearly 3 years, due to the presence of ACE2 receptors that "put the new coronavirus into the cell" on the surface of the human small intestinal mucosal cells, digestive tract symptoms caused by new crown infection are not uncommon, and sometimes even become the main complaint symptoms
of patients.

In some foreign studies, the proportion of new crown patients reporting digestive tract symptoms at the time of presentation is even as high as 40-60% [2-3], diarrhea, nausea, vomiting, abdominal pain, and loss of appetite are quite common; At six months after diagnosis, 29% of patients still reported having gastrointestinal symptoms that they believed to be related to the new crown infection [4].

Based on these circumstances, scholars from many countries have specially organized a prospective study of "GI-Covid-19" to deeply analyze the severity, causes and solutions of digestive tract symptoms in new crown patients, which is also the data source of
this study.

The reason why the researchers took IBS out alone is because viral and bacterial infections are known to be one of the most important risk factors for IBS, and the impact of IBS on the quality of life of patients is also more obvious, if the new crown infection will also lead to more IBS, the future should be paid attention to
.

A total of 614 adult COVID patients requiring hospitalization and no prior history of digestive diseases between May and October 2020 were included in the study, and 269 hospitalized patients with non-COVID causes and overall similar baseline status were set up as controls to assess the incidence
of gastrointestinal symptoms, post-infection IBS and anxiety/depression symptoms in both populations.

Baseline data showed that the incidence of digestive tract symptoms was significantly higher in hospitalized patients with new crown (59.
3%/39.
7%, P<0.
001), mainly nausea (28.
8%/12.
6%), diarrhea (37.
3%/9.
4%), unformed stool (27.
2%/7.
9%) and urgency (15.
9%/4.
9%), most of which showed mild-moderate symptoms
.

At 6 and 12 months of follow-up after discharge, the incidence of constipation (16%/9.
6% at 12 months) and dry stool (17.
7%/10.
9% at 12 months) were significantly lower in hospitalized patients, and there was no significant difference
in the incidence of other long-term gastrointestinal symptoms.

According to the Rome IV criteria (the main point is the presence of recurrent abdominal pain, at least once a week in the past 3 months, and related to bowel movements [5]), a total of 14 (3.
2%) new crown hospitalized patients were diagnosed with IBS after discharge, the proportion was more than 6 times that of the control group (1 case, 0.
5%), and 7 of them were diarrhea type (IBS-D).

However, it is worth noting that half of the new crown hospitalized patients are still diagnosed with other types of IBS, such as constipation (IBS-C
).
In addition, the proportion of hospitalized patients diagnosed with entero-brain axis interaction diseases (DGBI) such as functional dyspepsia was also higher, but there was no statistically significant difference
.

Multivariate analysis of the whole study population showed that a history of allergies and long-term use of proton pump inhibitors were associated with an increased risk of IBS.
For COVID patients only, risk factors also include antibiotics within 3 months before hospitalization or hospitalization, cough and dyspnea symptoms at admission, and anxiety 6 months after discharge
.

Risk factors associated with confirmed IBS

Researchers believe that the long-term presence of new coronavirus antigens in the intestine leads to persistent inflammation and autoimmune activation, which may explain the increased incidence of IBS in hospitalized patients with new crowns, but factors such as gut microbes and changes in the gut-brain axis may also be involved, and it is not so easy
to solve the problem.

It is currently thought that the possible mechanism leading to the sequelae of the digestive tract after new crown infection

(Credit: Nature Reviews Gastroenterology & Hepatology)

This puzzle will be left to scientists to solve, as the same "Yangkang" personnel as everyone, the singularity cake will definitely focus on the digestive tract next, and it is necessary to go to the hospital, after all, it is more correct to
clear the diagnosis and then symptomatic treatment than to blindly drink montmorillonite with a frown.

References:

[1] Marasco G, Cremon C, Barbaro M R, et al.
Post COVID-19 irritable bowel syndrome[J].
Gut, 2022: gutjnl-2022-328483.

[2] Zoghi G, Moosavy S H, Yavarian S, et al.
Gastrointestinal implications in COVID-19[J].
BMC Infectious Diseases, 2021, 21: 1135.

[3] Redd W D, Zhou J C, Hathorn K E, et al.
Prevalence and characteristics of gastrointestinal symptoms in patients with severe acute respiratory syndrome coronavirus 2 infection in the United States: a multicenter cohort study[J].
Gastroenterology, 2020, 159(2): 765-767.
e2.

[4] Blackett J W, Wainberg M, Elkind M S V, et al.
Potential long coronavirus disease 2019 gastrointestinal symptoms 6 months after coronavirus infection are associated with mental health symptoms[J].
Gastroenterology, 2022, 162(2): 648-650.
e2.

[5] Barbara G, Grover M, Bercik P, et al.
Rome foundation working team report on post-infection irritable bowel syndrome[J].
Gastroenterology, 2019, 156(1): 46-58.
e7.

The author of this article Tan Shuo