COVID-19会增加未来患胃肠道疾病的风险吗？

概要

在最近发表在《病毒》杂志上的一项研究中，科学家们回顾了现有文献，以探索急性SARS-CoV-2感染与胃肠道症状发生率之间的关系。大约50%的肠易激综合征（IBS）患者会出现并发症的主要表现为焦虑的心理健康状况，这会影响到日常生活。同样，也有患者会经历新冠后遗症，如情绪低落、抑郁和焦虑。该研究还讨论了与新冠后遗症和胃肠道疾病相关的身体和精神疾病负担。

研究指出，在感染SARS-CoV-2的患者中经常报告各种胃肠道症状，包括腹泻、味觉障碍、厌食、恶心和呕血。值得注意的是，味觉障碍和腹泻是常见的长新冠症状。

目前学界已经提出了广泛的病理生理机制来解释SARS-CoV-2感染是如何影响胃肠道系统。SARS-CoV-2与血管紧张素转换酶-2（ACE-2）受体结合，该受体在小肠和大肠的回肠肠细胞中高表达。这种结合可能会减少色氨酸的吸收并损害血管紧张素稳态，从而导致炎症和肠道微生物生态失调。而且在许多情况下，在急性SARS-CoV-2感染期间观察到肠道微生物组的改变。更具体地说，在急性COVID-19患者中发现有益肠道微生物的消耗和胃肠道中机会性病原体的增加。即使在康复后，微生物生态失调也会随着时间的推移而恶化。从新冠中恢复后，还观察到高水平的干扰素β（IFN-β）和IFN-λ2，以及病毒物质在肠上皮中的持久性。

多项研究表明，与一般人群相比，在有新冠病史的个体中发现胃肠道疾病的发病率更高，包括IBS、肝病、消化不良和自身免疫介导的疾病。

Does COVID-19 increase the risk of future gastrointestinal disorders?

The rapid outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) resulted in the coronavirus disease 2019 (COVID-19) pandemic. Several post-COVID conditions have been reported, including those affecting the gastrointestinal system.

In a recent study published in Viruses, scientists review existing literature to examine the association between acute SARS-CoV-2 infection and the incidence of gastrointestinal symptoms.

About 50% of patients with irritable bowel syndrome (IBS) develop a concurrent mental health condition, mostly anxiety, which affects their daily life. Likewise, some patients experience low mood, depression, and anxiety as a post-COVID syndrome. The current review also discusses the physical and mental disease burden associated with both post-COVID syndrome and gastrointestinal illness.

Study: A Systematic Review of the Prevalence of Persistent Gastrointestinal Symptoms and Incidence of New Gastrointestinal Illness after Acute SARS-CoV-2 Infection. Image Credit: SHISANUPONG1986 / Shutterstock.com

How does SARS-CoV-2 affect the gastrointestinal system?

Several studies have reported post-COVID syndrome, or long-COVID, which persists for more than twelve weeks from the onset of the infection. Based on self-reported data from the United Kingdom, about 3.3% of the general population developed long-COVID as of January 2023.

Various gastrointestinal symptoms including diarrhea, dysgeusia, anorexia, nausea, and hematemesis are frequently reported in patients who have been infected with SARS-CoV-2. Notably, dysgeusia and diarrhea are common long-COVID symptoms.

A wide range of pathophysiological mechanisms have been proposed to explain how SARS-CoV-2 infection impacts the gastrointestinal system. SARS-CoV-2 binds with the angiotensin-converting enzyme-2 (ACE-2) receptor, which is highly expressed in ileal enterocytes present in the small and large intestines. This binding may decrease tryptophan absorption and impair angiotensin homeostasis, subsequently leading to inflammation and gut microbial dysbiosis.

In many cases, alterations in the gut microbiome have been observed during acute SARS-CoV-2 infection. More specifically, a depletion of beneficial gut microorganisms and an increase of opportunistic pathogens in the gastrointestinal tract have been found in patients with acute COVID-19.

Even after recovery, microbial dysbiosis worsens over time. High levels of interferon β (IFN-β) and IFN-λ1, as well as the persistence of SARS-CoV-2 viral matter in the intestinal epithelium, have also been observed after recovery from COVID-19.

About the study

All relevant studies related to COVID-19 and gastrointestinal symptoms or illness published between December 2019 and July 3, 2023, were obtained from different databases including SCOPUS, OVID MedLine, and Europe PubMed Central. Pre-publications posted to the medRxiv preprint server were also included in the analysis.

The current review assessed all observational studies, including cohort, case-control, and cross-sectional studies. One of the key inclusion criteria is that patients included in these studies must experience ongoing gastrointestinal symptoms or new gastrointestinal illnesses beyond acute COVID-19 infection.

Study findings

After removing duplicate articles, the initial search resulted in a total of 2,549 studies, 45 of which satisfied all the inclusion criteria and were considered in the review. Taken together, these studies comprised 2,224,790 patients with persistent gastrointestinal symptoms following SARS-CoV-2 infection.

The studies were conducted in twenty-eight different countries throughout the world and reported the prevalence of persistent gastrointestinal symptoms for up to a maximum of eighteen months following recovery from COVID-19. After infection, a higher incidence of gastrointestinal illness linked to motility disorders, functional impairments, autoimmune-mediated illness, and hepatic issues were observed.

A high rate of inter-study heterogeneity was observed due to data obtained from varied settings associated with changing circumstances. Many studies have indicated that a significant number of individuals could be susceptible to persistent post-COVID gastrointestinal symptoms. As compared to controls, a higher prevalence of diarrhea, nausea, vomiting, and abdominal pain was observed in patients previously infected with SARS-CoV-2.

COVID-19 symptoms differed based on the SARS-CoV-2 variant and healthcare-seeking behaviors of the individual. One study reported that children with a history of SARS-CoV-2 infection attended the hospital’s emergency department due to abdominal pain.

A higher incidence of IBS was also found between three and six months after COVID-19. However, one study disagreed with this finding and stated that children with a history of COVID-19 are protected from developing persistent diarrhea and nausea one month following infection.

An association between COVID-19 and the development of autoimmune-mediated gastrointestinal illness has been reported by a limited number of studies. This finding is based on the molecular mimicry hypothesis. Notably, a similar rate of incidence of Clostridium difficile infection was observed between SARS-CoV-2-exposed and unexposed patients.

No evidence was obtained on the hospitalization rate for gastrointestinal infections due to previous SARS-CoV-2 infections in the older population. Thus, it is possible that the implementation of non-pharmaceutical interventions (NPIs) to restrict SARS-CoV-2 transmission also reduced enteric infections.

In some cases, oral or intravenous antibiotic treatment led to persistent diarrhea and/or dysphagia. This treatment was identified to be a strong predictor for post-COVID gastrointestinal sequelae.

Limited studies have reported an incidence of low mood among patients with persistent post-COVID gastrointestinal symptoms. However, no strong evidence could establish an association between persistent gastrointestinal symptoms and anxiety, low mood, and sleep disturbance.

Conclusions

Several studies have indicated the prevalence of post-infection functional gastrointestinal symptoms up to eighteen months after COVID-19 recovery. In the current study, as compared to the general population, a higher rate of gastrointestinal illnesses, including IBS, hepatic disease, dyspepsia, and autoimmune-mediated illnesses, was found among individuals with a history of COVID-19.

Source：

News Medical

Published on 2 August, 2023

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