Acute gastrointestinal and post-acute COVID-19 gastrointestinal syndrome assessment on the Gastrointestinal Symptom Rating Scale scoring system: A questionnaire-based survey
Authors: Singh Sunita , Srivastava Niraj K. , Yadav Rahul , Paul Saurabh , Gupta Shefali , Sankalp  , Dixit Priyanshi 
Published: December 2024

ABSTRACT

Background:
Post-acute coronavirus disease 2019 (COVID-19) syndrome (PACS) is the persistence of sequel of acute SARS-COV-2 infection. Persistent/acquired gastrointestinal symptoms (GI-PACS) include loss of appetite, nausea, weight loss, abdominal pain, heartburn, dysphagia, altered bowel motility, dyspepsia, and irritable bowel syndrome. The study aimed to assess the short- and long-term GI-PACS syndrome on the GSRS scale.

Methods:
A cross-sectional, retrospective record analysis and telephonic questionnaire-based survey were conducted at a tertiary referral center in northern India. The data incorporated patients treated from April 2021 to March 2023. Exclusion criteria were neurological disorders, dementia, inability to understand Hindi/English languages, and psychiatric problems. All patients who met the inclusion criteria were telephonically called from November 2023 to January 2024.

Results:
The study population was 350 recovered patients from SARS-COVID-19 illness. Forty-three responses were removed during data cleaning and removal of duplication. The data analysis of 307 participants (ICU admissions=92, non-ICU admissions=123, and outdoor treatment =92) was done. The proportion of patients not having any GI symptoms, having at least one GI symptom, and having more than one GI symptom before SARS-COV-2 illness was 3%(3/307), 4.9% (15/307), and 3.6% (11/307), respectively. The four major GI symptoms analyzed in the study were vomiting, pain in the abdomen, diarrhea, and constipation. Overall, 13% (40/307) of the study population did not have any major GI symptoms before SARS-COV-2 diseases. During acute SARS-COV-2 illness, 86.97% (267/307) of patients develop new GI symptoms. Post SARS-COV-2 illness, the overall mean GSRS score for 15 items was 2.14 ± 0.829. The acquired GI-PACS was abdominal pain syndrome (mean score 2.5190 ± SD 0.86650), constipation syndrome (mean score 2.3844 ± 0.83840), reflux syndrome (mean score 2.2866 ± 1.31889), indigestion syndrome (mean score 1.8591 ± 0.93076), and diarrhea syndrome (mean score 1.8122 ± 0.90899). Overall, fever (95.1%, P = 0.007), anosmia (45.0%, P = 0.042), cough (80.1%, P = 0.032), and hospitalization (30.0%, P = 0.003) had a more significant association with one of the major four GI symptoms during the acute phase of SARS-COV-2 illness. Home-isolated patients having loss of appetite (95.4%, P = 0.0001) had a significant association with one of the major four GI symptoms during the acute phase of SARS-COV-2 illness. Hospitalized patients having fever (80.7%, P = 0.031), breathlessness (83.8%, P = 0.003), loss of smell (97.0%, P = 0.001), and cough (82.7%, P = 0.048) had a more significant association with one of the major four GI symptoms during the acute SARS-COV-2 illness. Abdominal pain, reflux, and constipation were considered severe GI symptoms (symptom GSRS score greater than total mean GSRS score). Diarrhea and indigestion were considered mild symptoms (symptom GSRS score was less than the total mean GSRS score). The GI symptoms during acute SARS-COV-2 illness recovered in 66.1% (203/307) patients within 3 months. The respondents taking medicines for more than 1 year following SARS-COV-2 illness were 19.2%. 12.0% (37/307) of respondents suffered from persistent GI symptoms on a mean follow-up of 20.1 ± 0.82 months.

Conclusion:
Long-term COVID-19 syndrome frequently manifested as GI symptoms, whereas most symptoms subsided with time.