One GI Symptom Stuck Around Months After Severe COVID
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Gastrointestinal (GI) symptoms are highly prevalent in COVID-19 ranging from 17.6% to 53%. The proposed mechanism for GI symptoms involves SARS-CoV-2 virus binding to the host cell's angiotensin-converting enzyme 2 (ACE2) receptor, commonly found in gastrointestinal tract epithelial cells.
With an increasing population of patients recovering from acute infection, there is now interest in understanding post-COVID-19 sequelae. Our study aims to report gastrointestinal sequelae 3 and 6 months after hospitalization for COVID-19 infection.

This is a multicenter, retrospective study of hospitalized adult patients (18 years and older) who tested positive for COVID-19 infection across 12 hospitals comprising the Northwell Health System in New York. Patients were included if 1) tested positive for SARS-CoV-2 nasal swab PCR 2) were hospitalized with GI manifestations on initial presentation 3) had 3 and/or 6 months follow up as an outpatient post-hospitalization or repeat hospitalization. Further description of methods included in supplemental material.

During the study period, 17,462 COVID-19 patients were hospitalized. Of the 17,462 patients, 3,229 (18.5%) also had GI manifestations. A total of 715 (22.1%) patients had 788 (24.4%) distinct GI manifestations and also had 3 and/or 6 months outpatient follow up data post-discharge. Initial GI symptoms were as follows: gastroenteritis in 414 (52.5%), GI bleeding in 161 (20.4%), malnutrition in 181 (23.0%) and idiopathic pancreatitis in 4 (0.5%) patients. Gastroenteritis resolved in 323 (90.5%) patients at 3 months and 210 (89.4%) at 6 months.

GI bleeding resolved in 138 (92.0%) patients at 3 months and 89 (94.7%) at 6 months. Inability for weight regain remains present in 81 (50.6%) patients at 3 months and 33 (32.4%) at 6 months. Pancreatitis attributed to a viral etiology resolved in all patients at 3 months and 6 months. For patients with malnutrition, median weight on admission was 156.4 pounds. Median weight loss for patients at 3 months was -4.9 pounds and at 6 months -2.2 pounds respectively. Interestingly, 81 (59.1%) patients were unable to gain weight at 3 months and 44 (56.4 %) were unable to gain weight at 6 months. For patients with malnutrition unable to gain weight at follow up, median weight loss was -14.7 pounds at 3 months and -17.8 pounds at 6 months.

This study provides reassurance that most individuals with the onset of GI bleeding or gastroenteritis associated with COVID-19 infection will have resolution of these symptoms. The study highlights the need to pay particular attention to COVID-19 patients who suffer from malnutrition during their initial hospitalization. Many of these patients may have on-going malnutrition or weight loss despite resolution of COVID-19 infection. Therefore it may be imperative to establish malnutrition screening practices in post-COVID 19 patients who have recovered from acute infection.