Singh Sunita, Srivastava Niraj K, Yadav Rahul, Paul Saurabh, Gupta Shefali, Dixit Priyanshi
Department of Paediatric Surgery, All India Institute of Medical Sciences, Raebareli, Uttar Pradesh, India.
Department of General Surgery, All India Institute of Medical Sciences, Raebareli, Uttar Pradesh, India.
J Family Med Prim Care. 2024 Dec;13(12):5787-5798. doi: 10.4103/jfmpc.jfmpc_707_24. Epub 2024 Dec 9.
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.
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.
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%, = 0.007), anosmia (45.0%, = 0.042), cough (80.1%, = 0.032), and hospitalization (30.0%, = 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%, = 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%, = 0.031), breathlessness (83.8%, = 0.003), loss of smell (97.0%, = 0.001), and cough (82.7%, = 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.
Long-term COVID-19 syndrome frequently manifested as GI symptoms, whereas most symptoms subsided with time.
2019年冠状病毒病（COVID-19）后急性综合征（PACS）是急性严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染后遗症的持续存在。持续性/获得性胃肠道症状（GI-PACS）包括食欲不振、恶心、体重减轻、腹痛、烧心、吞咽困难、肠道动力改变、消化不良和肠易激综合征。本研究旨在通过胃肠道症状评定量表（GSRS）评估短期和长期的GI-PACS综合征。
在印度北部的一家三级转诊中心进行了一项横断面、回顾性记录分析和基于电话问卷的调查。数据纳入了2021年4月至2023年3月接受治疗的患者。排除标准为神经系统疾病、痴呆、无法理解印地语/英语以及精神问题。2023年11月至2024年1月，通过电话联系了所有符合纳入标准的患者。
研究人群为350例从SARS-COVID-19疾病中康复的患者。在数据清理和去除重复项过程中，去除了43份回复。对307名参与者（重症监护病房入院患者=92例，非重症监护病房入院患者=123例，门诊治疗患者=92例）进行了数据分析。在感染SARS-CoV-2之前，没有任何胃肠道症状、至少有一个胃肠道症状以及有多个胃肠道症状的患者比例分别为3%（3/307）、4.9%（15/307）和3.6%（11/307）。本研究分析的四大胃肠道症状为呕吐、腹痛、腹泻和便秘。总体而言，13%（40/307）的研究人群在感染SARS-CoV-2之前没有任何主要胃肠道症状。在急性SARS-CoV-2感染期间，86.97%（267/307）的患者出现了新的胃肠道症状。感染SARS-CoV-2后，15项指标的总体平均GSRS评分为2.14±0.829。获得性GI-PACS为腹痛综合征（平均评分为2.5190±标准差0.86650）、便秘综合征（平均评分为2.3844±0.83840）、反流综合征（平均评分为2.2866±1.31889）、消化不良综合征（平均评分为1.8591±0.93076）和腹泻综合征（平均评分为1.8122±0.90899）。总体而言，发热（95.1%，P=0.007）、嗅觉丧失（45.0%，P=0.042）、咳嗽（80.1%，P=0.032）和住院（30.0%，P=0.003）与SARS-CoV-2感染急性期四大主要胃肠道症状之一的关联更为显著。居家隔离的食欲不振患者（95.4%，P=0.0001）与SARS-CoV-2感染急性期四大主要胃肠道症状之一的关联显著。住院患者中，发热（80.7%，P=0.031）、呼吸困难（83.8%，P=0.003）、嗅觉丧失（97.0%，P=0.001）和咳嗽（82.7%，P=0.048）与急性SARS-CoV-2感染期间四大主要胃肠道症状之一的关联更为显著。腹痛、反流和便秘被认为是严重的胃肠道症状（症状GSRS评分高于总体平均GSRS评分）。腹泻和消化不良被认为是轻度症状（症状GSRS评分低于总体平均GSRS评分）。66.1%（203/307）的患者在急性SARS-CoV-2感染期间的胃肠道症状在3个月内恢复。感染SARS-CoV-2后服用药物超过1年的受访者占19.2%。在平均20.1±0.82个月的随访中，12.0%（37/307）的受访者患有持续性胃肠道症状。
长期COVID-19综合征常表现为胃肠道症状，而大多数症状会随时间消退。
