Blackett John W, Elkind Mitchell S V, O'Byrne Sheila, Wainberg Milton, Purpura Lawrence, Chang Lin, Freedberg Daniel E
Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, New York.
Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York.
Gastro Hep Adv. 2023 Jun 30;2(7):918-924. doi: 10.1016/j.gastha.2023.06.006. eCollection 2023.
It is unclear to what degree post-COVID-19 gastrointestinal (GI) symptoms are caused by the SARS-CoV-2 virus vs psychological factors related to the stress of the pandemic. To evaluate this, we compared rates of long-term GI and mental health symptoms in patients testing positive vs negative for SARS-CoV-2.
Adults presenting for SARS-CoV-2 testing from April to November 2020 were prospectively enrolled in a longitudinal cohort. Six to 12 months later, the presence and severity of current GI and mental health symptoms were assessed on a 5-point Likert scale. A multivariable logistic regression model was used to estimate the odds of a positive COVID test for predicting GI symptoms, stratified by sadness/anxiety.
749 COVID-positive and 107 COVID-negative patients completed the survey. The prevalence of at least one GI symptom was higher in patients with COVID-19 (29 vs 18%, = .01). However, after stratifying by sadness/anxiety, differences in GI symptoms according to COVID status were no longer significant. On multivariable analysis, the adjusted odds ratio for GI symptoms was 8.26 (95% CI 4.04-16.9) for positive COVID sadness/anxiety, 8.74 (95% CI 2.63-29.0) for negative COVID sadness/anxiety, and 1.16 (95% CI 0.57-2.39) for positive COVID sadness/anxiety, compared to a reference group of negative COVID sadness/anxiety.
After accounting for sadness and anxiety, there was no association between COVID-19 and the development of long-term GI symptoms. Post-COVID GI symptoms may be mediated bidirectionally through coexisting anxiety and depression, similar to disorders of gut-brain interaction.
目前尚不清楚新冠病毒感染后胃肠道（GI）症状在多大程度上是由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）病毒引起的，还是与疫情压力相关的心理因素导致的。为了评估这一点，我们比较了SARS-CoV-2检测呈阳性和阴性患者的长期胃肠道和心理健康症状发生率。
2020年4月至11月前来进行SARS-CoV-2检测的成年人被前瞻性纳入一个纵向队列。6至12个月后，采用5分李克特量表评估当前胃肠道和心理健康症状的存在情况及严重程度。使用多变量逻辑回归模型估计新冠检测呈阳性以预测胃肠道症状的几率，并按悲伤/焦虑程度进行分层。
749名新冠阳性患者和107名新冠阴性患者完成了调查。新冠病毒感染患者中至少出现一种胃肠道症状的患病率更高（29%对18%，P = 0.01）。然而，在按悲伤/焦虑程度分层后，根据新冠状态划分的胃肠道症状差异不再显著。在多变量分析中，与新冠阴性且无悲伤/焦虑的参照组相比，新冠阳性且有悲伤/焦虑时胃肠道症状的调整优势比为8.26（95%置信区间4.04 - 16.9），新冠阴性且有悲伤/焦虑时为8.74（95%置信区间2.63 - 29.0），新冠阳性且无悲伤/焦虑时为1.16（95%置信区间0.57 - 2.39）。
在考虑悲伤和焦虑因素后，新冠病毒感染与长期胃肠道症状的发生之间没有关联。新冠后胃肠道症状可能通过共存的焦虑和抑郁双向介导，类似于肠脑互动障碍。
