Bowel symptoms associated with coronavirus disease 19 in hospitalized patients with moderate to severe illness
DOI:
https://doi.org/10.31686/ijier.vol10.iss12.4011
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Diarrhea, COVID-19, Constipation, Surveys and QuestionnairesAbstract
Bowel symptoms, such as diarrhea, have higher prevalence during coronavirus disease 2019 (COVID-19). The correlation between the severity of these symptoms and their prognosis has not been defined yet. Furthermore, higher prevalence of gastrointestinal symptoms after recovery from COVID-19 has been reported. This study aimed to analyze the correlation of potential factors with the severity of diarrhea during COVID-19 and to assess the progression of post-COVID-19 bowel symptoms. This prospective longitudinal cohort included 109 patients with moderate to severe COVID-19 symptoms who were hospitalized from May to July 2021. Patients were interviewed to assess the presence and intensity of bowel symptoms during COVID-19 and 3–6 months after hospital discharge using the Gastrointestinal Symptom Rating Scale questionnaire. Demographic and clinical data were obtained and their correlations with the intensity of bowel symptoms were examined. The presence of severe diarrhea was correlated with the need for ventilatory support and the use of anticoagulants but not with the use of antibiotics. In addition, bowel symptoms, such as loose stools and incomplete evacuation but not diarrhea, constipation, or abdominal pain, persisted for at least 3–6 months after hospital discharge. These results suggest that the severity of diarrhea during COVID-19 may be associated with worsening of the disease and that only loose stools and incomplete evacuation are present after COVID-19. The chronicity of these bowel symptoms should be evaluated to improve the treatment of patients with COVID-19.
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Gupta, A., Madhavan, M. V., Sehgal, K., Nair, N., Mahajan, S., Sehrawat, T. S., et al. (2020). Extrapulmonary manifestations of COVID-19. Nature medicine, 26(7), 1017-1032. doi: 10.1038/s41591-020-0968-3. DOI: https://doi.org/10.1038/s41591-020-0968-3
Livanos, A. E., Jha, D., Cossarini, F., Gonzalez-Reiche, A. S., Tokuyama, M., Aydillo, T., et al. (2021). Intestinal host response to SARS-CoV-2 infection and COVID-19 outcomes in patients with gastrointestinal symptoms. Gastroenterology, 160: 2435-2450.e.34. doi: 10.1053/j.gastro.2021.02.056. DOI: https://doi.org/10.1053/j.gastro.2021.02.056
Nobel, Y. R., Phipps, M., Zucker, J., Lebwohl, B., Wang, T. C., Sobieszczyk, M. E., et al. (2020). Gastrointestinal symptoms and coronavirus disease 2019: a case-control study from the United States. Gastroenterology, 159:373-375.e.2. doi: 10.1053/j.gastro.2020.04.017. DOI: https://doi.org/10.1053/j.gastro.2020.04.017
Pan L, Mu M, Yang P, Sun Y, Wang R, Yan J, et al. (2020). Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study. The American journal of gastroenterology, 115:766-773. doi: 10.14309/ajg.0000000000000620. PMID: 32287140. DOI: https://doi.org/10.14309/ajg.0000000000000620
Mao, R., Qiu, Y., He, J. S., Tan, J. Y., Li, X. H., Liang, J., et al. (2020). Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis. The lancet Gastroenterology & hepatology, 5:667-678. doi: 10.1016/S2468-1253(20)30126-6. DOI: https://doi.org/10.1016/S2468-1253(20)30126-6
Wan, Y., Li, J., Shen, L., Zou, Y., Hou, L., Zhu, L., et al. (2020). Enteric involvement in hospitalized patients with COVID-19 outside Wuhan. The lancet Gastroenterology & hepatology, 5:534-535. doi: 10.1016/S2468-1253(20)30118-7. DOI: https://doi.org/10.1016/S2468-1253(20)30118-7
Patel, H. K., Kovacic, R., Chandrasekar, V. T., Patel, S. C., Singh, M., Le Cam, E., et al. (2022). Correlation of Gastrointestinal Symptoms at Initial Presentation with Clinical Outcomes in Hospitalized COVID-19 Patients: Results from a Large Health System in the Southern USA. Digestive Diseases and Sciences, 7:1-10. doi: 10.1007/s10620-022-07384-0. DOI: https://doi.org/10.1007/s10620-022-07384-0
Elmunzer, B. J., Spitzer, R. L., Foster, L. D., Merchant, A. A., Howard, E. F., Patel, V. A., et al. (2019). Digestive manifestations in patients hospitalized with coronavirus disease 2019. Clinical gastroenterology and hepatology, 19:1355-1365.e4. doi: 10.1016/j.cgh.2020.09.041. DOI: https://doi.org/10.1016/j.cgh.2020.09.041
Aghemo, A., Piovani, D., Parigi, T. L., Brunetta, E., Pugliese, N., Vespa, E., et al. (2020). COVID-19 digestive system involvement and clinical outcomes in a large academic hospital in Milan, Italy. Clinical Gastroenterology and Hepatology,18:2366-2368.e3. doi: 10.1016/j.cgh.2020.05.011. DOI: https://doi.org/10.1016/j.cgh.2020.05.011
Blackett, J. W., Li, J., Jodorkovsky, D., & Freedberg, D. E. (2022). Prevalence and risk factors for gastrointestinal symptoms after recovery from COVID‐19. Neurogastroenterology & Motility, 34:e14251. doi: 10.1111/nmo.14251. DOI: https://doi.org/10.1111/nmo.14251
Mayer, E. A., Craske, M., & Naliboff, B. D. (2001). Depression, anxiety, and the gastrointestinal system. Journal of Clinical Psychiatry, 62, 28-37.
Choi, E. P. H., Hui, B. P. H., & Wan, E. Y. F. (2020). Depression and anxiety in Hong Kong during COVID-19. International journal of environmental research and public health, 17(10), 3740. doi: 10.3390/ijerph17103740. DOI: https://doi.org/10.3390/ijerph17103740
Schmulson, M., Ghoshal, U. C., & Barbara, G. (2021). Managing the inevitable surge of post–COVID-19 functional gastrointestinal disorders. Official journal of the American College of Gastroenterology| ACG, 116(1), 4-7. doi: 10.14309/ajg.0000000000001062. DOI: https://doi.org/10.14309/ajg.0000000000001062
Svedlund, J., Sjödin, I., & Dotevall, G. (1988). GSRS—a clinical rating scale for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease. Digestive diseases and sciences, 33(2), 129-134. doi: 10.1007/BF01535722. DOI: https://doi.org/10.1007/BF01535722
Souza, G. S., Sardá, F. A. H., Giuntini, E. B., Gumbrevicius, I., Morais, M. B. D., & Menezes, E. W. D. (2016). Translation and validation of the brazilian portuguese version of the Gastrointestinal Symptom Rating Scale (GSRS) Questionnaire. Arquivos de Gastroenterologia, 53, 146-151. doi: 10.1590/S0004-28032016000300005. DOI: https://doi.org/10.1590/S0004-28032016000300005
Scully, E. P., Haverfield, J., Ursin, R. L., Tannenbaum, C., & Klein, S. L. (2020). Considering how biological sex impacts immune responses and COVID-19 outcomes. Nature Reviews Immunology, 20(7), 442-447. doi: 10.1038/s41577-020-0348-8. DOI: https://doi.org/10.1038/s41577-020-0348-8
de Souza, F. S. H., Hojo-Souza, N. S., Batista, B. D. D. O., da Silva, C. M., & Guidoni, D. L. (2021). On the analysis of mortality risk factors for hospitalized COVID-19 patients: A data-driven study using the major Brazilian database. PloS one, 16(3), e0248580. doi: 10.1371/journal.pone.0248580. DOI: https://doi.org/10.1371/journal.pone.0248580
Xu, K., Chen, Y., Yuan, J., Yi, P., Ding, C., Wu, W., et al. (2020). Factors associated with prolonged viral RNA shedding in patients with coronavirus disease 2019 (COVID-19). Clinical infectious diseases, 71(15), 799-806. doi: 10.1093/cid/ciaa351. DOI: https://doi.org/10.1093/cid/ciaa351
Zheng, S., Fan, J., Yu, F., Feng, B., Lou, B., Zou, Q., et al. (2020). Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January-March 2020: retrospective cohort study. British medical journal, 369:m1443. doi: 10.1136/bmj.m1443. DOI: https://doi.org/10.1136/bmj.m1443
Liu, H., Chen, S., Liu, M., Nie, H., & Lu, H. (2020). Comorbid chronic diseases are strongly correlated with disease severity among COVID-19 patients: a systematic review and meta-analysis. Aging and disease, 11(3), 668. doi: 10.14336/AD.2020.0502. DOI: https://doi.org/10.14336/AD.2020.0502
Yonekawa, A., & Shimono, N. (2022). Clinical Significance of COVID-19 and Diabetes: In the Pandemic Situation of SARS-CoV-2 Variants including Omicron (B. 1.1. 529). Biology, 11(3), 400. doi: 10.3390/biology11030400. DOI: https://doi.org/10.3390/biology11030400
Leung, W. K., To, K. F., Chan, P. K., Chan, H. L., Wu, A. K., Lee, N., et al. (2003). Enteric involvement of severe acute respiratory syndrome-associated coronavirus infection. Gastroenterology, 125(4), 1011-1017. doi: 10.1016/s0016-5085(03)01215-0. DOI: https://doi.org/10.1016/S0016-5085(03)01215-0
Rees, E. M., Nightingale, E. S., Jafari, Y., Waterlow, N. R., Clifford, S., B Pearson, C. A., et al. (2020). COVID-19 length of hospital stay: a systematic review and data synthesis. BMC medicine, 18(1), 1-22. doi: 10.1186/s12916-020-01726-3. DOI: https://doi.org/10.1186/s12916-020-01726-3
Marcolino, M. S., Ziegelmann, P. K., Souza-Silva, M. V., Nascimento, I. J. B. D., Oliveira, L. M., Monteiro, L. S., et al. (2021). Clinical characteristics and outcomes of patients hospitalized with COVID-19 in Brazil: Results from the Brazilian COVID-19 registry. International Journal of infectious diseases, 107, 300-310. doi: 10.1016/j.ijid.2021.01.019. DOI: https://doi.org/10.1016/j.ijid.2021.01.019
Rawson, T. M., Moore, L. S., Zhu, N., Ranganathan, N., Skolimowska, K., Gilchrist, M., ... & Holmes, A. (2020). Bacterial and fungal coinfection in individuals with coronavirus: a rapid review to support COVID-19 antimicrobial prescribing. Clinical infectious diseases, 71(9), 2459-2468. doi: 10.1093/cid/ciaa530. DOI: https://doi.org/10.1093/cid/ciaa530
Xiao, F., Tang, M., Zheng, X., Liu, Y., Li, X., & Shan, H. (2020). Evidence for gastrointestinal infection of SARS-CoV-2. Gastroenterology, 158(6), 1831-1833. doi: 10.1053/j.gastro.2020.02.055. DOI: https://doi.org/10.1053/j.gastro.2020.02.055
Lee, N., Hui, D., Wu, A., Chan, P., Cameron, P., Joynt, G. M., et al. (2003). A major outbreak of severe acute respiratory syndrome in Hong Kong. New England Journal of Medicine, 348(20), 1986-1994. doi: 10.1056/NEJMoa030685. DOI: https://doi.org/10.1056/NEJMoa030685
Zoghi, G., Moosavy, S. H., Yavarian, S., HasaniAzad, M., Khorrami, F., Sharegi Brojeni, M., et al. (2021). Gastrointestinal implications in COVID-19. BMC Infectious Diseases, 21(1), 1-9. doi: 10.1186/s12879-021-06824-y. DOI: https://doi.org/10.1186/s12879-021-06824-y
Wong, S. H., Lui, R. N., & Sung, J. J. (2020). Covid‐19 and the digestive system. Journal of gastroenterology and hepatology, 35(5), 744-748. doi: 10.1111/jgh.15047. DOI: https://doi.org/10.1111/jgh.15047
Giron, L. B., Dweep, H., Yin, X., Wang, H., Damra, M., Goldman, A. R., et al. (2021). Plasma markers of disrupted gut permeability in severe COVID-19 patients. Frontiers in immunology, 12, 686240. doi: 10.3389/fimmu.2021.686240. DOI: https://doi.org/10.3389/fimmu.2021.779064
Liu, J., Cui, M., Yang, T., & Yao, P. (2020). Correlation between gastrointestinal symptoms and disease severity in patients with COVID-19: a systematic review and meta-analysis. BMJ Open Gastroenterol, 7:e000437. doi: 10.1136/bmjgast-2020-000437. DOI: https://doi.org/10.1136/bmjgast-2020-000437
Aiyegbusi, O. L., Hughes, S. E., Turner, G., Rivera, S. C., McMullan, C., Chandan, J. S., et al. (2021). Symptoms, complications and management of long COVID: a review. Journal of the Royal Society of Medicine, 114(9), 428-442. doi: 10.1177/01410768211032850. DOI: https://doi.org/10.1177/01410768211032850
Ford, A. C., Sperber, A. D., Corsetti, M., & Camilleri, M. Irritable bowel syndrome. Lancet, 396:1675-1688. doi: 10.1016/S0140-6736(20)31548-8. DOI: https://doi.org/10.1016/S0140-6736(20)31548-8
Zuo, T., Zhang, F., Lui, G. C., Yeoh, Y. K., Li, A. Y., Zhan, H., et al. (2020). Alterations in gut microbiota of patients with COVID-19 during time of hospitalization. Gastroenterology, 159(3), 944-955. doi: 10.1053/j.gastro.2020.05.048. DOI: https://doi.org/10.1053/j.gastro.2020.05.048
Kaźmierczak-Siedlecka, K., Vitale, E., & Makarewicz, W. (2020). COVID-19-gastrointestinal and gut microbiota-related aspects. European Review for Medical and Pharmacological Sciences, 24(20), 10853-10859. doi: 10.26355/eurrev_202010_23448.
Noviello, D., Costantino, A., Muscatello, A., Bandera, A., Consonni, D., Vecchi, M., et al. (2022). Functional gastrointestinal and somatoform symptoms five months after SARS‐CoV‐2 infection: A controlled cohort study. Neurogastroenterology & Motility, 34(2), e14187. doi: 10.1111/nmo.14187. DOI: https://doi.org/10.1111/nmo.14187
Santos-Júnior, J. C. M. (2005). Constipação intestinal. Revista Brasileira de Coloproctologia, 25:79-93.
Coles, M. J., Masood, M., Crowley, M. M., Hudgi, A., Okereke, C., & Klein, J. (2022). It Ain’t Over'Til It's Over: SARS CoV-2 and Post-infectious Gastrointestinal Dysmotility. Digestive Diseases and Sciences, 1-9. doi: 10.1007/s10620-022-07480. DOI: https://doi.org/10.1007/s10620-022-07480-1
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Copyright (c) 2022 Suliana Mesquita Paula, Larissa Gurgel Mota Saraiva, Dayllanna Stefanny Lopes Lima Feitosa, Rôney Reis de Castro Silva, Isabela Caldas Borges, Davi Veras Araújo, Sofia Santiago Marinho, Miguel Ângelo Nobre e Souza, Marcellus Henrique Loiola Ponte Souza
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Accepted 2022-11-18
Published 2022-12-01
