Original Articles, FUNCTIONAL BOWEL DISORDERS AFTER COVID-19
Abstract
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
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