• Attique Abou Bakr Allama Iqbal Medical College
  • Dr. Madiha Akram
  • Naeem Aslam
  • Fawad Iqbal Janjua


Objective: To assess gut-brain interaction disorders and gastrointestinal symptoms after COVID-19 hospitalisation.

Study Design:Prospective, controlled study.

Setting: Medical wards and ICUs of Jinnah Hospital Lahore, Mayo Hospital Lahore, DHQ Hospital Gujranwalla, and Hijaz Hospital Lahore.

Study duration: April 1, 2020–December 31, 2021.

Material and Methods:We enrolled 1284 patients (both COVID-19 and non-COVID-19) who met the inclusion criteria and followed them for 1, 6, and 12 months after hospital discharge. Informed verbal consent was obtained, and patients underwent a focused history and physical examination and had their demographic details were recorded. Nasopharyngeal swabs for COVID-19 PCR confirmed infection and excluded non-COVID cases. Positive results were labelled COVID-19 positive. Validated questionnaires measured depression, anxiety, and gastrointestinal symptoms. 881 patients were included in the primary analysis after excluding those with preexisting GI symptoms or surgery. (270 controls, 611 COVID-19).

Results: Out of 1284 hospitalised patients, 249 patients were not included in the analysis because they did not adhere to the study protocol (died), had missing questionnaire data, or were diagnosed with cancer during the course of the follow-up. 805 (62.7%) of the remaining 1035 had COVID-19, and 162 (94 COVID-19 and 68 control) were excluded due to pre-existing gastrointestinal symptoms or surgery. 873 subjects without pre-existing confounders were assessed and followed up for primary and secondary aim analysis. 746 patients completed 6-month and 603 patients completed 12-month follow-up evaluations. In primary aim analysis, mean age was 48.9 ±20.1 years for control group and 52.9±14.2 for COVID patients (p=0.47). 62.1% of control and 58.7% of COVID cases were male (p=0.54). BMI in control group was 24.8±7.5 and in COVID cases it was 23.9±7.6 (p=0.6). COVID-19 patients had more gastrointestinal symptoms at enrollment (65.5% vs 38.5%, p<0.0015). Controls (15.5%) have more constipation than COVID-19 patients (9.1%) at 12 months ( p=0.029 ). ROME  IV-defined IBS was higher in COVID-19 patients (4.0% vs. 0.3%, p=0.035). IBS was linked to allergies, dyspnoea, and proton pump inhibitors.At 6 months, the rate of depression among COVID-19 patients was higher than that of controls.

 CONCLUSIONS:  At 12 months, patients hospitalised with COVID-19 had less constipation and hard stools than controls. COVID-19 patients had significantly more IBS than controls. 

Keywords: COVID-19, Nasopharyngeal swab, ROME IV, Irritable Bowel syndrome



WHO Coronavirus (COVID-19) Dashboard. Who coronavirus (COVID-19) Dashboard with vaccination data. Available: https://covid19.who.int/ [Accessed 26 Feb 2022].

Marasco G, Cremon C, Barbaro MR, et al. Prevalence of gastrointestinal symptoms in severe acute respiratory syndrome coronavirus 2 infection: results of the prospective controlled multinational GI-COVID-19 study. Am J Gastroenterol 2022;117:147–57.

Goyal P, Choi JJ, Pinheiro LC, et al. Clinical characteristics of Covid-19 in New York City. N Engl J Med 2020;382:2372–4.

Jackson LA, Anderson EJ, Rouphael NG, et al. An mRNA Vaccine against SARS-CoV-2 - Preliminary Report. N Engl J Med 2020;383:1920–31.

Polack FP, Thomas SJ, Kitchin N, et al. Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine. N Engl J Med 2020;383:2603–15.

Mlcochova P, Kemp SA, Dhar MS, et al. SARS-CoV-2 B.1.617.2 delta variant replication and immune evasion. Nature 2021;599:114–9.

Hui KPY, Ho JCW, Cheung M-C, et al. SARS-CoV-2 omicron variant replication in human bronchus and lung ex vivo. Nature 2022;603:715–20.

Crook H, Raza S, Nowell J, et al. Long covid-mechanisms, risk factors, and management. BMJ 2021;374:n1648.

Nalbandian A, Sehgal K, Gupta A, et al. Post-Acute COVID-19 syndrome. Nat Med


Groff D, Sun A, Ssentongo AE, et al. Short-Term and long-term rates of Postacute sequelae of SARS-CoV-2 infection: a systematic review. JAMA Netw Open 2021;4:e2128568.

Marasco G, Lenti MV, Cremon C, et al. Implications of SARS-CoV-2 infection for neurogastroenterology. Neurogastroenterol Motil 2021;33:e14104.

Schmulson M, Ghoshal UC, Barbara G. Managing the inevitable surge of Post– COVID-19 functional gastrointestinal disorders. Am J Gastroenterol 2021;116:4–7.

Barbara G, Grover M, Bercik P, et al. Rome Foundation working team report on Post- Infection irritable bowel syndrome. Gastroenterology 2019;156:46–58.

Noviello D, Costantino A, Muscatello A, et al. Functional gastrointestinal and somatoform symptoms five months after SARS-CoV-2 infection: a controlled cohort study. Neurogastroenterol Motil 2022;34:e14187.

Yusuf F, Fahriani M, Mamada SS, et al. Global prevalence of prolonged gastrointestinal symptoms in COVID-19 survivors and potential pathogenesis: A systematic review and meta-analysis. F1000Res 2021;10:301.

Ghoshal UC, Ghoshal U, Rahman MM, et al. Post-infection functional gastrointestinal disorders following coronavirus disease-19: a case-control study. J Gastroenterol Hepatol 2022;37:489–98.

Diagnostic testing for SARS-CoV-2. Available: https://www.who.int/publications/i/ item/diagnostic-testing-for-sars-cov-2 [Accessed 02 Mar 2021].

Svedlund J, Sjödin I, Dotevall G. GSRS--a clinical rating scale for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease. Dig Dis Sci 1988;33:129–34.

Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67:361–70.

Palsson OS, Whitehead WE, van Tilburg MAL, et al. Rome IV diagnostic questionnaires and tables for Investigators and clinicians. Gastroenterology 2016;150:1481–91.

Ebrahim Nakhli R, Shanker A, Sarosiek I, et al. Gastrointestinal symptoms and the severity of COVID-19: disorders of gut-brain interaction are an outcome. Neurogastroenterol Motil 2022;34:e14368.

Al-Aly Z, Xie Y, Bowe B. High-Dimensional characterization of post-acute sequelae of COVID-19. Nature 2021;594:259–64.

Blackett JW, Wainberg M, Elkind MSV, et al. Potential long coronavirus disease 2019 gastrointestinal symptoms 6 months after coronavirus infection are associated with mental health symptoms. Gastroenterology 2022;162:648–50.

Klem F, Wadhwa A, Prokop LJ, et al. Prevalence, risk factors, and outcomes of irritable bowel syndrome after infectious enteritis: a systematic review and meta-analysis. Gastroenterology 2017;152:1042–54.

Koloski N, Jones M, Walker MM, et al. Population based study: atopy and autoimmune diseases are associated with functional dyspepsia and irritable bowel syndrome, independent of psychological distress. Aliment Pharmacol Ther 2019;49:546–55.

Burns G, Carroll G, Mathe A, et al. Evidence for local and systemic immune activation in functional dyspepsia and the irritable bowel syndrome: a systematic review. Am J Gastroenterol 2019;114:429–36.

Barbara G, Stanghellini V, De Giorgio R, et al. Activated mast cells in proximity to colonic nerves correlate with abdominal pain in irritable bowel syndrome. Gastroenterology 2004;126:693–702.

Barbara G, Wang B, Stanghellini V, et al. Mast cell-dependent excitation of

visceral-nociceptive sensory neurons in irritable bowel syndrome. Gastroenterology


Robles A, Perez Ingles D, Myneedu K, et al. Mast cells are increased in the small intestinal mucosa of patients with irritable bowel syndrome: a systematic review and meta-analysis. Neurogastroenterol Motil 2019;31:e13718.

Fernández-de-Las-Peñas C, Martín-Guerrero JD, Navarro-Pardo E, et al. Exploring the recovery curve for gastrointestinal symptoms from the acute COVID-19 phase to long-term post-COVID: the LONG-COVID-EXP-CM multicenter study. J Med Virol 2022;94:2925–7.

Zuo T, Zhang F, Lui GCY, et al. Alterations in gut microbiota of patients with COVID-19 during time of hospitalization. Gastroenterology 2020;159:944–55.

Gu S, Chen Y, Wu Z, et al. Alterations of the gut microbiota in patients with coronavirus disease 2019 or H1N1 influenza. Clin Infect Dis 2020;71:2669–78.

Li G-F, An X-X, Yu Y, et al. Do proton pump inhibitors influence SARS-CoV-2 related outcomes? A meta-analysis. Gut 2021;70:1806–8.

Liu Q, Mak JWY, Su Q, et al. Gut microbiota dynamics in a prospective cohort of patients with post-acute COVID-19 syndrome. Gut 2022;71:544–52.

Su Y, Yuan D, Chen DG, et al. Multiple early factors anticipate post-acute COVID-19 sequelae. Cell 2022;185:881–95.

Porter CK, Faix DJ, Shiau D, et al. Postinfectious gastrointestinal disorders following norovirus outbreaks. Clin Infect Dis 2012;55:915–22.

Gaebler C, Wang Z, Lorenzi JCC, et al. Evolution of antibody immunity to SARS-CoV-2.

Nature 2021;591:639–44.

Phetsouphanh C, Darley DR, Wilson DB, et al. Immunological dysfunction persists for 8 months following initial mild-to-moderate SARS-CoV-2 infection. Nat Immunol 2022;23:210–6.

Sun J, Xiao J, Sun R, et al. Prolonged persistence of SARS-CoV-2 RNA in body fluids.

Emerg Infect Dis 2020;26:1834–8.

Journal of Akhtar Saeed Medical & Dental College



How to Cite

Abou Bakr, A., Akram, D. M., Aslam, N., & Iqbal, F. (2024). Original Articles, FUNCTIONAL BOWEL DISORDERS AFTER COVID-19. Journal of Akhtar Saeed Medical & Dental College, 5(04), 212–220. Retrieved from https://amdc.edu.pk/Ojs/ojs-3.3/index.php/jamdc/article/view/232