— More severe post-COVID gastrointestinal symptoms also increased the risk for anxiety and sadness
by Zaina Hamza
Mental health symptoms in people who recovered from COVID-19 were associated with post-infection gastrointestinal (GI) symptoms, a survey-based study found.
In an analysis of nearly 750 individuals who had COVID-19, those with mental health symptoms either before or after their infection were more than 16 times more likely to have post-COVID GI symptoms (adjusted odds ratio [aOR] 16.5, 95% CI 6.97-38.9), reported John Blackett, MD, MS, of the Mayo Clinic in Rochester, Minnesota, and colleagues.
New mental health symptoms following infection were also tied to post-COVID GI symptoms (aOR 6.16, 95% CI 4.21-9.01), according to the findings in Gastroenterology.
“This is consistent with prior studies showing that psychological distress is a risk factor for developing a post-infection functional GI disorder, which has not previously been evaluated after COVID,” Blackett told MedPage Today. “Clinicians should be aware of the high prevalence of GI symptoms in patients with ‘long COVID,’ and that these symptoms often go hand in hand with psychiatric symptoms.”
“We do not know whether the psychiatric symptoms are a cause or a result of the GI symptoms, but we suspect it is likely to be both,” he added.
Overall, COVID-related GI symptoms were reported in 29% of respondents at 6 months following their COVID-19 diagnosis, including symptoms of heartburn (16%), constipation (11%), diarrhea (9.6%), abdominal pain (9.4%), and nausea or vomiting (7%). Notably, 11% of patients reported having a GI symptom as the “most bothersome current symptom.”
Post-COVID GI symptoms were twice as frequent among respondents who had been hospitalized for COVID-19, at 51% versus 26% in those not hospitalized (aOR 2.3, 95% CI 1.38-3.84), suggesting that infection severity increases the risk of these symptoms, the authors said.
Patients with pre-COVID mental health symptoms had a higher risk of post-COVID GI symptoms (49% vs 28% for those without, P=0.01). And patients reporting anxiety or sadness after their infection also had a higher risk of post-COVID GI symptoms (55% vs 14% for those without, P<0.01). Increasing GI symptom severity was tied to higher risk for anxiety or sadness (P=0.02).
“While all patients with chronic GI symptoms should receive screening for comorbid mental health symptoms, this study provides specific evidence that screening COVID-19 survivors will be high yield,” the group wrote.
“It’s not surprising to learn that anxiety and sadness are linked with chronic gastrointestinal symptoms in post-COVID patients, and that certainly fits with what we’re seeing in our GI clinics,” said Jane A. Roberts, MD, PhD, of the University of Vermont Medical Center in Burlington, who was not involved in the study. “Hopefully future studies will be able to shed light on some of the reasons why this pattern has emerged, so that we can better help this population.”
For their study, Blackett and colleagues surveyed 1,783 patients who had tested positive for COVID-19 at the Columbia University Irving Medical Center from April to November 2020 and survived their infection, with 749 responding to the survey. Among the cohort, 15% were hospitalized for COVID-19 and 1.7% needed mechanical ventilation. Patients were included if they had at least 6 months of follow-up.
Most of the respondents were white (61%), while 28% were Hispanic and 10% were Black. Two-thirds were women, and the median age was 43. Among the 220 reporting GI symptoms, 27.7% reported mild symptoms, 14.6% moderate, 11.4% severe, and 7.7% very severe. Neither Black race nor Hispanic ethnicity were associated with post-COVID GI symptoms, though preference for Spanish language was (aOR 2.55, 95% CI 1.14-5.73).
Mental health symptoms were less common before versus after a COVID-19 diagnosis (5% vs 37%). Anxiety and sadness were the most commonly cited mental health symptoms in either scenario.
Among the 33 respondents with post-COVID abdominal pain, 13 (39%) met the ROME IV diagnostic criteria for irritable bowel syndrome (IBS) after reporting weekly pain and stool changes for a minimum of 6 months. Post-COVID IBS incidence or GI symptoms did not differ based on gender.