PERSISTENT GASTROINTESTINAL SYMPTOMS AND CHRONIC FATIGUE AFTER SARS-COV-2 INFECTION.
Presentation Number: 782View Presentation
AuthorBlock: Daniele Noviello1, Andrea Costantino2, Antonio Muscatello2, Dario Consonni2, Maurizio Vecchi1,2, Guido Basilisco2
1Universita degli Studi di Milano, Milano, Italy; 2Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy;
Background/Aim: Acute gastrointestinal infections are associated with an increased risk of developing functional gastrointestinal disorders and chronic fatigue syndrome. The digestive system is vulnerable to SARS-CoV-2 infection, but the point whether gastrointestinal symptoms and chronic fatigue persist after the infection has not been fully established. We have investigated the prevalence of gastrointestinal symptoms and chronic fatigue by means of a structured questionnaire after the resolution of SARS-CoV-2 infection.
Methods: 378 subjects, age range 18-60 years, were studied. 177 patients had a molecular diagnosis of SARS-CoV-2 infection at our hospital in Feb-Apr 2020; 201 subjects, who had been tested because living in the same house as other infected people or working at the hospital, had a negative test in the same period (control group). 13 and 18 patients were respectively excluded because of a previous gastrointestinal disease, 9 and 16 of them with Irritable Bowel Syndrome (IBS). All the subjects filled in a web-based structured questionnaire about 5 months after infection. 164 patients (mean age 44 years, 40% female) and 183 control subjects (mean age 40 years, 61% female) completed the study. Their clinical data, acute SARS-CoV-2 related symptoms, the presence and severity of 22 gastrointestinal symptoms grouped in five symptom domains and the presence of six extra-intestinal symptoms including chronic fatigue were recorded according to the Structured Assessment of Gastrointestinal Symptoms (SAGIS) questionnaire. The Rome IV criteria for IBS, Bristol Stool scale, SCL 12 for somatoform disorders and HADS (Hospital Anxiety and Depression Scale) for anxiety and depression were also recorded. Association between exposure to SARS-CoV-2 infection and symptoms was evaluated by both univariate (chi-squared and Mann-Whitney tests) and multivariate analysis (linear and robust Poisson regression models).
Results: Fever, shortness of breath, loss of smell and taste, fatigue, muscle pain, diarrhea, weight loss and antibiotic treatment were more frequent in patients during the infection (results not shown). After the infection resolving, the severity of abdominal pain/discomfort and diarrhea/incontinence symptoms was greater in patients than in controls (Table 1) as was the frequency of patients with chronic fatigue (31.7% vs. 13.7%; P<0.001). The frequency of IBS according to the Rome IV criteria, loose stools, SCL 12 for somatoform disorders and HADS –A and –D for anxiety and depression scores tended to be greater in patients than in controls (Table 2).
Conclusions: The results of this controlled study show that abdominal pain/discomfort, diarrhea and chronic fatigue persist after SARS-CoV-2 infection in a significant proportion of patients. Our results suggest that SARS-CoV-2 may affect the brain-gut axis in the long term.