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Reviews on Recent Clinical Trials

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ISSN (Print): 1574-8871
ISSN (Online): 1876-1038

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Mini-Review Article

Post-COVID-19 Gastro-Intestinal Disturbances

Author(s): Emidio Scarpellini* and Jan Tack

Volume 18, Issue 1, 2023

Published on: 20 January, 2023

Page: [34 - 40] Pages: 7

DOI: 10.2174/1574887118666221201104833

Price: $65

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Abstract

Background: Since the end of 2019, SARS-CoV-2 has been responsible for the multisystemic hyper-inflammatory disease, namely, COVID-19, as a majorly impactful pandemic. Gastrointestinal (GI) symptoms occurring during and after disease are gaining increasing attention among experts.

Methods: We briefly review and comment on preliminary and recent evidences on prevalence, pathophysiology, and perspective treatment options for GI disturbances during and after COVID-19.

Results: Several reports from the literature show a significant portion of COVID-19 patients suffering from GI symptoms both at the early stages of the disease and after the end of it, sometimes for several months, namely “long-COVID-19” patients, irrespective of vaccination. An unsolved issue regarding COVID-19 is the association between GI symptoms and the outcome of COVID-19 patients. Several studies and metanalyses suggest a worse evolution of COVID-19 in patients presenting with GI symptoms. However, these data have not been agreed. Indeed, only one uniform observation can be found in the literature: patients with chronic liver disease have a worse outcome from COVID-19 infection. Upper and lower GI symptoms have similarities with postinfectious functional dyspepsia (FD) and irritable bowel syndrome (IBS). FD and IBS following infection are recognize as pathophysiological factor the gut microbial, which is a gut microbial quali- and quantitative unbalance, namely dysbiosis. Furthermore, several preliminary reports and ongoing clinical trials have shown gut microbiota modulation by pre-, pro- and postbiotics to be effective in changing and preventing COVID-19 natural course.

Conclusion: GI symptoms characterize both long- and non-long-COVID-19 with a potentially significant impact on its natural course. Gut microbiota modulation seems to be a sensible target for disease treatment and/or prevention.

Keywords: COVID-19, functional dyspepsia, irritable bowel syndrome, gut microbiota, dysbiosis, probiotics.

« Previous Next »
[1]
Peters SE, Dennerlein JT, Wagner GR, Sorensen G. Work and worker health in the post-pandemic world: A public health perspective. Lancet Public Health 2022; 7(2): e188-94.
[http://dx.doi.org/10.1016/S2468-2667(21)00259-0] [PMID: 35122760]
[2]
Rabaan AA, Bakhrebah MA, Mutair AA, et al. Systematic review on pathophysiological complications in severe COVID-19 among the non-vaccinated and vaccinated population. Vaccines 2022; 10(7): 985.
[http://dx.doi.org/10.3390/vaccines10070985] [PMID: 35891149]
[3]
Yusuf F, Fahriani M, Mamada SS, et al. Global prevalence of prolonged gastrointestinal symptoms in COVID-19 survivors and potential pathogenesis: A systematic review and meta-analysis. F1000 Res 2021; 10: 301.
[4]
Wang Y, Li Y, Zhang Y, Liu Y, Liu Y. Are gastrointestinal symptoms associated with higher risk of mortalityin COVID-19 patients? A systematic review and meta-analysis. BMC Gastroenterol 2022; 22(1): 106.
[http://dx.doi.org/10.1186/s12876-022-02132-0] [PMID: 35255816]
[5]
Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet 2020; 395(10223): 507-13.
[http://dx.doi.org/10.1016/S0140-6736(20)30211-7] [PMID: 32007143]
[6]
Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for gastrointestinal infection of SARS-CoV-2. Gastroenterology 2020; 158(6): 1831-1833.e3.
[http://dx.doi.org/10.1053/j.gastro.2020.02.055] [PMID: 32142773]
[7]
Gu J, Han B, Wang J. COVID-19: Gastrointestinal manifestations and potential fecal-oral transmission. Gastroenterology 2020; 158(6): 1518-9.
[http://dx.doi.org/10.1053/j.gastro.2020.02.054] [PMID: 32142785]
[8]
Ong J, Young BE, Ong S. COVID-19 in gastroenterology: A clinical perspective. Gut BMJ Publishing Group 2020; pp. 1144-5.
[9]
Carfì A, Bernabei R, Landi F. Persistent symptoms in patients after acute COVID-19. JAMA 2020; 324(6): 603-5.
[http://dx.doi.org/10.1001/jama.2020.12603] [PMID: 32644129]
[10]
Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: A single-centered, retrospective, observational study. Lancet Respir Med 2020; 8(5): 475-81.
[http://dx.doi.org/10.1016/S2213-2600(20)30079-5] [PMID: 32105632]
[11]
Mao R, Qiu Y, He JS, et al. Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: A systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2020; 5(7): 667-78.
[http://dx.doi.org/10.1016/S2468-1253(20)30126-6] [PMID: 32405603]
[12]
Tan ND, Qiu Y, Xing XB, Ghosh S, Chen MH, Mao R. Associations between angiotensin-converting enzyme inhibitors and angiotensin II receptor blocker use, gastrointestinal symptoms, and mortality among patients with COVID-19. Gastroenterology 2020; 159(3): 1170-1172.e1.
[http://dx.doi.org/10.1053/j.gastro.2020.05.034] [PMID: 32422208]
[13]
Iavarone M, D’Ambrosio R, Soria A, et al. High rates of 30-day mortality in patients with cirrhosis and COVID-19. J Hepatol 2020; 73(5): 1063-71.
[http://dx.doi.org/10.1016/j.jhep.2020.06.001] [PMID: 32526252]
[14]
An P, Chen H, Ren H, et al. Gastrointestinal symptoms onset in COVID-19 patients in Wuhan, China. Dig Dis Sci 2021; 66(10): 3578-87.
[http://dx.doi.org/10.1007/s10620-020-06693-6] [PMID: 33180244]
[15]
Atalla E, Zhang R, Shehadeh F, et al. Clinical presentation, course, and risk factors associated with mortality in a severe outbreak of COVID-19 in Rhode Island, USA, April–June 2020. Pathogens 2020; 10(1): 8.
[http://dx.doi.org/10.3390/pathogens10010008] [PMID: 33374131]
[16]
Caillard S, Anglicheau D, Matignon M, et al. An initial report from the French SOT COVID Registry suggests high mortality due to COVID-19 in recipients of kidney transplants. Kidney Int 2020; 98(6): 1549-58.
[http://dx.doi.org/10.1016/j.kint.2020.08.005] [PMID: 32853631]
[17]
Chadalavada P, Padbidri V, Garg R, et al. Transaminases are potential biomarkers of disease severity in COVID-19 patients: A single-center experience. Cureus 2020; 12(11): e11555.
[http://dx.doi.org/10.7759/cureus.11555] [PMID: 33365223]
[18]
Chen R, Yu Y, Li W, et al. Gastrointestinal symptoms associated with unfavorable prognosis of COVID-19 patients: A retrospective study. Front Med 2020; 7: 608259.
[http://dx.doi.org/10.3389/fmed.2020.608259] [PMID: 33262996]
[19]
Chen T, Wu D, Chen H, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: Retrospective study. BMJ 2020; 368: m1091.
[http://dx.doi.org/10.1136/bmj.m1091] [PMID: 32217556]
[20]
Comoglu Ş, Öztürk S, Kant A, Arslan M, Karakoc HN, Yılmaz G. Evaluation of diarrhea in patients with COVID-19. Dig Dis 2021; 39(6): 622-5.
[http://dx.doi.org/10.1159/000515521] [PMID: 33647911]
[21]
Crespo M, Mazuecos A, Rodrigo E, et al. Respiratory and gastrointestinal COVID-19 phenotypes in kidney transplant recipients. Transplantation 2020; 104(11): 2225-33.
[http://dx.doi.org/10.1097/TP.0000000000003413] [PMID: 32804802]
[22]
Doganci S, Ince ME, Ors N, et al. A new COVID-19 prediction scoring model for in-hospital mortality: Experiences from Turkey, single center retrospective cohort analysis. Eur Rev Med Pharmacol Sci 2020; 24(19): 10247-57.
[PMID: 33090436]
[23]
Du H, Dong X, Zhang J, et al. Clinical characteristics of 182 pediatric COVID-19 patients with different severities and allergic status. Allergy 2021; 76(2): 510-32.
[http://dx.doi.org/10.1111/all.14452] [PMID: 32524611]
[24]
Elimian KO, Ochu CL, Ebhodaghe B, et al. Patient characteristics associated with COVID-19 positivity and fatality in Nigeria: Retrospective cohort study. BMJ Open 2020; 10(12): e044079.
[PMID: 33334842]
[25]
Ferm S, Fisher C, Pakala T, et al. Analysis of gastrointestinal and hepatic manifestations of SARS-CoV-2 infection in 892 Patients in Queens, NY. Clin Gastroenterol Hepatol 2020; 18(10): 2378-2379.e1.
[http://dx.doi.org/10.1016/j.cgh.2020.05.049] [PMID: 32497637]
[26]
Gayam V, Chobufo MD, Merghani MA, Lamichhane S, Garlapati PR, Adler MK. Clinical characteristics and predictors of mortality in African-Americans with COVID-19 from an inner-city community teaching hospital in New York. J Med Virol 2021; 93(2): 812-9.
[http://dx.doi.org/10.1002/jmv.26306] [PMID: 32672844]
[27]
Ghoshal UC, Ghoshal U, Mathur A, et al. The spectrum of gastrointestinal symptoms in patients with Coronavirus Disease-19: Predictors, relationship with disease severity, and outcome. Clin Transl Gastroenterol 2020; 11(12): e00259.
[http://dx.doi.org/10.14309/ctg.0000000000000259] [PMID: 33463978]
[28]
Hajifathalian K, Krisko T, Mehta A, et al. Gastrointestinal and hepatic manifestations of 2019 novel coronavirus disease in a large cohort of infected patients from New York: Clinical implications. Gastroenterology 2020; 159(3): 1137-1140.e2.
[http://dx.doi.org/10.1053/j.gastro.2020.05.010] [PMID: 32389667]
[29]
Huang H, Zhang M, Chen C, et al. Clinical characteristics of COVID-19 in patients with preexisting ILD: A retrospective study in a single center in Wuhan, China. J Med Virol 2020; 92(11): 2742-50.
[http://dx.doi.org/10.1002/jmv.26174] [PMID: 32533777]
[30]
Jiang Y, Abudurexiti S, An MM, Cao D, Wei J, Gong P. Risk factors associated with 28-day all-cause mortality in older severe COVID-19 patients in Wuhan, China: A retrospective observational study. Sci Rep 2020; 10(1): 22369.
[http://dx.doi.org/10.1038/s41598-020-79508-3] [PMID: 33353956]
[31]
Jin X, Lian JS, Hu JH, et al. Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut 2020; 69(6): 1002-9.
[http://dx.doi.org/10.1136/gutjnl-2020-320926] [PMID: 32213556]
[32]
Kang MK, Kim KO, Kim MC, et al. Clinical characteristics of coronavirus disease 2019 patients with diarrhea in Daegu. Korean J Intern Med 2020; 35(6): 1261-9.
[http://dx.doi.org/10.3904/kjim.2020.196] [PMID: 32872734]
[33]
Kim D, Adeniji N, Latt N, et al. Predictors of outcomes of COVID-19 in patients with chronic liver disease: US Multi-center Study. Clin Gastroenterol Hepatol 2021; 19(7): 1469-1479.e19.
[http://dx.doi.org/10.1016/j.cgh.2020.09.027] [PMID: 32950749]
[34]
Lanthier N, Mahiat C, Henrard S, et al. Gastro-intestinal symptoms are associated with a lower in-hospital mortality rate in frail older patients hospitalized for COVID-19. Acta Gastroenterol Belg 2021; 84(1): 135-6.
[http://dx.doi.org/10.51821/84.1.824] [PMID: 33639706]
[35]
Laszkowska M, Faye AS, Kim J, et al. Disease course and outcomes of COVID-19 among hospitalized patients with gastrointestinal manifestations. Clin Gastroenterol Hepatol 2021; 19(7): 1402-1409.e1.
[http://dx.doi.org/10.1016/j.cgh.2020.09.037] [PMID: 33007514]
[36]
Leal T, Costa E, Arroja B, Gonçalves R, Alves J. Gastrointestinal manifestations of COVID-19: Results from a European centre. Eur J Gastroenterol Hepatol 2021; 33(5): 691-4.
[http://dx.doi.org/10.1097/MEG.0000000000002152] [PMID: 33787540]
[37]
Liang J, Jin G, Liu T, et al. Clinical characteristics and risk factors for mortality in cancer patients with COVID-19. Front Med 2021; 15(2): 264-74.
[http://dx.doi.org/10.1007/s11684-021-0845-6] [PMID: 33754280]
[38]
Liu J, Tao L, Liu X, et al. GI symptoms and fever increase the risk of severe illness and death in patients with COVID-19. Gut 2021; 70(2): 442-4.
[PMID: 32606209]
[39]
Livanos AE, Jha D, Cossarini F, et al. Intestinal host response to SARS-CoV-2 infection and COVID-19 outcomes in patients with gastrointestinal symptoms. Gastroenterology 2021; 160(7): 2435-2450.e34.
[http://dx.doi.org/10.1053/j.gastro.2021.02.056] [PMID: 33676971]
[40]
Luo S, Deng Z, Zhang X, Pan Z, Xu H. Clinical characteristics and outcomes of 2019 novel coronavirus disease patients presenting with initial gastrointestinal symptoms in Wuhan, China: A retrospective cohort study. J Gastroenterol Hepatol 2021; 36(3): 694-9.
[http://dx.doi.org/10.1111/jgh.15199] [PMID: 32721038]
[41]
Ma X, Li A, Jiao M, et al. Characteristic of 523 COVID-19 in Henan province and a death prediction model. Front Public Health 2020; 8: 475.
[http://dx.doi.org/10.3389/fpubh.2020.00475] [PMID: 33014973]
[42]
Montazeri M, Maghbouli N, Jamali R, et al. Clinical characteristics of COVID-19 patients with gastrointestinal symptoms. Arch Iran Med 2021; 24(2): 131-8.
[http://dx.doi.org/10.34172/aim.2021.21] [PMID: 33636982]
[43]
Moura DTH, Proença IM, McCarty TR, et al. Gastrointestinal manifestations and associated health outcomes of COVID-19: A Brazilian experience from the largest South American Public Hospital. Clinics 2020; 75: e2271.
[http://dx.doi.org/10.6061/clinics/2020/e2271] [PMID: 33146362]
[44]
Pan L, Mu M, Yang P, et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei; China: A descriptive; cross-sectional; multicenter study. Am J Gastroenterol 2020; 115(5): 766-73.
[http://dx.doi.org/10.14309/ajg.0000000000000620] [PMID: 32287140]
[45]
Peng X, Chen Y, Deng L, et al. Clinical features of critically ill patients infected with SARS-CoV-2 outside Wuhan with and without diabetes. Int J Diabetes Dev Ctries 2020; 40(4): 482-90.
[http://dx.doi.org/10.1007/s13410-020-00888-3] [PMID: 33169053]
[46]
Ramachandran P, Onukogu I, Ghanta S, et al. Gastrointestinal symptoms and outcomes in hospitalized Coronavirus Disease 2019 patients. Dig Dis 2020; 38(5): 373-9.
[http://dx.doi.org/10.1159/000509774] [PMID: 32599601]
[47]
Redd WD, Zhou JC, Hathorn KE, et al. Prevalence and characteristics of gastrointestinal symptoms in patients with SARS-CoV-2 infection in the United States: A multicenter cohort study. Gastroenterology 2020; 159: 765-7.
[http://dx.doi.org/10.1053/j.gastro.2020.04.045] [PMID: 32333911]
[48]
Renelus BD, Khoury N, Chandrasekaran K, Bekele E, Briggs WM, Jamorabo DS. Hospitalized coronavirus disease-2019 (COVID-19) patients with gastrointestinal symptoms have improved survival to discharge. Dig Liver Dis 2020; 52(12): 1403-6.
[http://dx.doi.org/10.1016/j.dld.2020.08.043] [PMID: 32948489]
[49]
Russell B, Moss C, Papa S, et al. Factors affecting COVID-19 outcomes in cancer patients: A first report from Guy’s Cancer Center in London. Front Oncol 2020; 10: 1279.
[http://dx.doi.org/10.3389/fonc.2020.01279] [PMID: 32903324]
[50]
Schettino M, Pellegrini L, Picascia D, et al. Clinical characteristics of COVID-19 patients with gastrointestinal symptoms in Northern Italy: A single-center cohort study. Am J Gastroenterol 2021; 116(2): 306-10.
[http://dx.doi.org/10.14309/ajg.0000000000000965] [PMID: 33009054]
[51]
Shang H, Bai T, Chen Y, et al. Outcomes and implications of diarrhea in patients with SARS-CoV-2 infection. Scand J Gastroenterol 2020; 55(9): 1049-56.
[http://dx.doi.org/10.1080/00365521.2020.1800078] [PMID: 32749177]
[52]
Soares RCM, Mattos LR, Raposo LM. Risk factors for hospitalization and mortality due to COVID-19 in Espírito Santo State, Brazil. Am J Trop Med Hyg 2020; 103(3): 1184-90.
[http://dx.doi.org/10.4269/ajtmh.20-0483] [PMID: 32682453]
[53]
Sulaiman T, Algharawi AA, Idrees M, et al. The prevalence of gastrointestinal symptoms among patients with COVID -19 and the effect on the severity of the disease. JGH Open 2020; 4(6): 1162-6.
[http://dx.doi.org/10.1002/jgh3.12415] [PMID: 33043143]
[54]
Vena A, Giacobbe DR, Di Biagio A, et al. Clinical characteristics, management and in-hospital mortality of patients with coronavirus disease 2019 in Genoa, Italy. Clin Microbiol Infect 2020; 26(11): 1537-44.
[http://dx.doi.org/10.1016/j.cmi.2020.07.049] [PMID: 32810610]
[55]
Villanego F, Mazuecos A, Pérez-Flores IM, et al. Predictors of severe COVID-19 in kidney transplant recipients in the different epidemic waves: Analysis of the Spanish Registry. Am J Transplant 2021; 21(7): 2573-82.
[http://dx.doi.org/10.1111/ajt.16579] [PMID: 33756067]
[56]
Vrillon A, Hourregue C, Azuar J, et al. COVID -19 in older adults: A series of 76 patients aged 85 years and older with COVID -19. J Am Geriatr Soc 2020; 68(12): 2735-43.
[http://dx.doi.org/10.1111/jgs.16894] [PMID: 33045106]
[57]
Wan Y, Li J, Shen L, et al. Enteric involvement in hospitalised patients with COVID-19 outside Wuhan. Lancet Gastroenterol Hepatol 2020; 5(6): 534-5.
[http://dx.doi.org/10.1016/S2468-1253(20)30118-7] [PMID: 32304638]
[58]
Wang X, Xu H, Jiang H, et al. Clinical features and outcomes of discharged coronavirus disease 2019 patients: A prospective cohort study. QJM 2020; 113(9): 657-65.
[http://dx.doi.org/10.1093/qjmed/hcaa178] [PMID: 32442308]
[59]
Zhang J, Wang X, Jia X, et al. Risk factors for disease severity, unimprovement, and mortality in COVID-19 patients in Wuhan, China. Clin Microbiol Infect 2020; 26(6): 767-72.
[http://dx.doi.org/10.1016/j.cmi.2020.04.012] [PMID: 32304745]
[60]
Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet 2020; 395(10229): 1054-62.
[http://dx.doi.org/10.1016/S0140-6736(20)30566-3] [PMID: 32171076]
[61]
Zhou Z, Zhao N, Shu Y, Han S, Chen B, Shu X. Effect of gastrointestinal symptoms in patients with COVID-19. Gastroenterology 2020; 158(8): 2294-7.
[http://dx.doi.org/10.1053/j.gastro.2020.03.020] [PMID: 32199880]
[62]
Fock KM. Functional dyspepsia, H. pylori and post infectious FD. J Gastroenterol Hepatol 2011; 26 (Suppl. 3): 39-41.
[http://dx.doi.org/10.1111/j.1440-1746.2011.06649.x] [PMID: 21443707]
[63]
Mearin F, Pérez-Oliveras M, Perelló A, et al. Dyspepsia and irritable bowel syndrome after a Salmonella gastroenteritis outbreak: One-year follow-up cohort study. Gastroenterology 2005; 129(1): 98-104.
[http://dx.doi.org/10.1053/j.gastro.2005.04.012] [PMID: 16012939]
[64]
Iacob T. Țățulescu D, Lupșe M, Dumitrașcu D. Post-infectious irritable bowel syndrome after a laboratory-proven enteritis. Exp Ther Med 2020; 20(4): 3517-22.
[http://dx.doi.org/10.3892/etm.2020.9018] [PMID: 32905134]
[65]
Scarpellini E, Ianiro G, Attili F, Bassanelli C, De Santis A, Gasbarrini A. The human gut microbiota and virome: Potential therapeutic implications. Dig Liver Dis 2015; 47(12): 1007-12.
[http://dx.doi.org/10.1016/j.dld.2015.07.008] [PMID: 26257129]
[66]
Kazemian N, Kao D, Pakpour S. Fecal microbiota transplantation during and Post-COVID-19 pandemic. Int J Mol Sci 2021; 22(6): 3004.
[http://dx.doi.org/10.3390/ijms22063004] [PMID: 33809421]
[67]
Nguyen QV, Chong LC, Hor YY, Lew LC, Rather IA, Choi SB. Role of probiotics in the management of COVID-19: A computational perspective. Nutrients 2022; 14(2): 274.
[http://dx.doi.org/10.3390/nu14020274] [PMID: 35057455]
[68]
Chen Y, Gu S, Chen Y, et al. Six-month follow-up of gut microbiota richness in patients with COVID-19. Gut 2022; 71(1): 222-5.
[http://dx.doi.org/10.1136/gutjnl-2021-324090] [PMID: 33833065]
[69]
Xu K, Cai H, Shen Y, et al. Management of COVID-19: The Zhejiang experience. Zhejiang Da Xue Xue Bao Yi Xue Ban 2020; 49(2): 147-57.
[70]
Akour A. Probiotics and COVID-19: Is there any link? Lett Appl Microbiol 2020; 71(3): 229-34.
[http://dx.doi.org/10.1111/lam.13334] [PMID: 32495940]
[71]
Dhar D, Mohanty A. Gut microbiota and COVID-19 possible link and implications. Virus Res 2020; 285: 198018.
[http://dx.doi.org/10.1016/j.virusres.2020.198018] [PMID: 32430279]
[72]
Li Q, Cheng F, Xu Q, et al. The role of probiotics in coronavirus disease-19 infection in Wuhan: A retrospective study of 311 severe patients. Int Immunopharmacol 2021; 95: 107531.
[http://dx.doi.org/10.1016/j.intimp.2021.107531] [PMID: 33714884]
[73]
Gutiérrez-Castrellón P, Gandara-Martí T, Abreu AT, et al. Efficacy and safety of novel probiotic formulation in adult COVID-19 outpatients: A randomized; placebo-controlled clinical trial. medRxiv 2021. Available from: https://www.scienceopen.com/document?vid=6094b73f-98ce-da6-9ff7-52c29b4dfb93

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