COVID-19 Increases Risk for Gastrointestinal and Autonomic Dysfunction

COVID-19 is associated with an increased risk for new-onset enteric nervous system and autonomic nervous system (ANS) dysfunction compared with negative control individuals and patients infected with neurotrophic and non-neurotrophic pathogens, according to study results presented at the American College of Gastroenterology (ACG) 2022 Annual Meeting, held from October 21 to 26, 2022, in Charlotte, North Carolina, and virtually.

The retrospective cohort study used data from the TriNetX Research Network, which includes more than 80 million patients from 57 academic medical centers in the United States. Participants were diagnosed with COVID-19 from January 1, 2020, to December 31, 2020.

The patients were propensity score-matched for risk factors with negative control individuals and patients diagnosed with either influenza, Lyme disease (LD), infectious mononucleosis (IM), herpes zoster (HZ), varicella zoster (VZ), and cytomegalovirus (CMV).

The hazard ratio (HR) and cumulative incidence of new-onset outcomes within 3 months and 1 year after diagnosis of a health event were estimated with use of Kaplan-Meier analysis. Health events included gastrointestinal (GI) symptoms or diagnoses and symptoms of autonomic neuropathy (AN), sensory neuropathy (SN), and motor neuropathy (MN). The investigators quantified the effect of previous vaccination for COVID-19 on these outcomes.

A total of 1,355,657 patients with COVID-19 were matched to 1,889,175 negative control individuals, 698,253 patients with influenza, 61,826 with IM, 129,246 with LD, 457,984 with HZ, 45,811 with VZ, and 8441 with CMV.

After COVID-19, the risk for GI diagnoses and AN was increased (hazard ratio [HR] >1, P <.05), compared with the other control populations, except for patients with GI diagnoses after CMV (HR 0.89, P =.26). COVID-19 significantly increased (P <.05) the risk for vomiting (HR, 1.78), diarrhea (HR, 1.53), and irritable bowel syndrome (HR, 1.07) vs the negative control group, but it was not different after influenza (P >.05).

COVID-19 also increased the risk for functional dyspepsia (HR, 1.09), inflammatory bowel disease (HR, 1.5), and abdominal pain (HR, 1.38) vs the negative control group. Influenza was associated with an even higher risk (P <.05). The risk was consistently increased (P <.05) for the other GI diagnoses vs the negative control group and those with influenza.

Previous vaccination for COVID-19 did not affect the risk for a GI outcome after COVID-19 (HR, 0.95, P =.32), although it did increase the risk for AN (HR, 1.13, P =.02) and MN (HR, 1.6, P <.05).

“Given the magnitude of COVID-19 infections, a significant increase in patients with dysmotility and ANS dysfunction is expected, for which gastroenterology as a specialty needs to prepare,” the study authors noted.

Disclosure: One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the author’s disclosures.