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A study of more than 11.6 million people published today in Nature Communications suggests that COVID-19 survivors are at increased risk for a range of gastrointestinal disorders at 1 year.

Researchers from the Veterans Affairs Saint Louis Health Care System used their national healthcare database to compare the gastrointestinal outcomes of 154,068 COVID-19 survivors with those of 5,638,795 contemporary uninfected controls and 5,859,621 prepandemic controls.

At 1 year postinfection, COVID-19 patients were more likely than controls to have gastroesophageal reflux disease (hazard ratio [HR], 1.35; burden, 15.50 per 1,000 people), peptic ulcer disease (HR, 1.62; burden, 1.57), pancreatitis (HR, 1.46; burden, 0.6), functional dyspepsia (HR, 1.36; burden, 0.63), gastritis (HR, 1.47; burden, 0.47), irritable bowel syndrome (HR, 1.54; burden, 0.44), and cholangitis (HR, 2.02; burden, 0.22). The respective risk and burden of a composite of any diagnosis were 1.37 and 17.37.

Signs and symptoms were constipation, abdominal pain, diarrhea, vomiting, and bloating. The risk and burden of a composite of all signs and symptoms were 1.54 and 24.02, respectively.

Elevated risk with severe COVID-19

Compared with the contemporary control group, the risk of having any gastrointestinal outcome was elevated among COVID-19 patients (HR, 1.36; burden, 62.34), regardless of age, sex, race, and underlying medical conditions. The risks were also heightened relative to historical controls, and a comparative analysis suggested that hospitalized COVID-19 patients were at increased risk of severe gastrointestinal symptoms relative to those hospitalized with flu.

These rates may translate into large number of affected people.

While nonhospitalized patients were also at elevated risk, the likelihood of gastrointestinal disorders gradually rose along with COVID-19 severity, with the greatest risk among those who were hospitalized or admitted to an intensive care unit.

“Although the absolute burdens (expressed per 1000 persons at 1-year) may appear small, because of the large number of people with SARS-CoV-2 infection, these rates may translate into large number of affected people,” the authors wrote. “This will have ramifications not only for the personal health of affected individuals, but also on health systems.”