Most patients with inflammatory bowel disease (IBD) who recovered from COVID-19 and were experiencing postacute sequelae of SARS-CoV-2 infection — also referred to as “long-haul COVID” — were found to have signs of SARS-CoV-2 in their gut tissues, according to study findings published in Gastroenterology.
Patients (N=46) with IBD who had confirmed SARS-CoV-2 infection were recruited at the Medical University Innsbruck in Austria. Patients underwent upper and lower endoscopy an average of 7.3 (range, 94-257) months after infection. Retrieved gut tissue samples were phenotyped, underwent RNA testing, immunofluorescence, enzyme-linked immunosorbent assay (ELISA), interferon gamma release assay (IGRA), and virus cultivation to assess for the presence of SARS-CoV-2.
The patient population included 56.5% men, the median age was 44.67 (IQR, 28.11-51.95) years, 67.4% had Crohn disease, 28.3% had ulcerative colitis, and 58.7% were in remission.
Most patients (n=32) tested positive for mucosal SARS-CoV-2. Patients with mucosal SARS-CoV-2 had shorter IBD duration (median, 24.96 vs 35.51 years; P =.02) and fewer were using medication at endoscopy (0.0% vs 14.3%; P =.03).
Stratified by tissue sample location (duodenum, ileum, and colon), 4 of the patients tested positive at all 3 locations, 9 tested positive at 2 locations, 19 at 1 location, and 14 at no locations. Viral RNA was detected in 31% of biopsies, RNA-dependent RNA polymerase in 13.6%, the Spike protein in 11.4%, the Nucleocapsid protein in 10.6%, and the Envelope protein in 6.1%.
No patient who tested negative for mucosal SARS-CoV-2 had long-haul COVID symptoms, whereas 65.6% of the cohort that tested positive had any postacute symptom (P =.001). The most common symptoms were fatigue (56.3%), memory issues (43.8%), loss of smell (34.4%), abdominal pain (28.1%), sleeping disorders (25.0%), persistent cough (21.9%), and shortness of breath (21.9%), among others.
Testing positive for mucosal SARS-CoV-2 was unrelated to fecal calprotectin (P =.40).
Study limitations included a small sample size. The findings should be confirmed in a larger, controlled trial, according to the study authors.
“Collectively, we provide evidence for SARS-CoV-2 antigen persistence in the gut as a basis for immune perturbation in postacute COVID-19,” the study authors wrote.
Zollner A, Koch R, Jukic A, et al. Post-acute COVID-19 is characterized by gut viral antigen persistence in inflammatory bowel diseases. Gastroenterology. Published online May 1, 2022. doi:10.1053/j.gastro.2022.04.037