ABSTRACT
Introduction: SARS-CoV-2 is known to infect the gastrointestinal tract and COVID-19 may manifest with gastrointestinal symptoms. Studies regarding the risks factors for COVID-19 and the impact of the pandemic on healthcare utilization in patients with functional gastrointestinal disorders (FGID) are lacking. Methods: We performed a retrospective study of consecutive patients with FGID (irritable bowel syndrome, gastroparesis, functional dyspepsia) who tested positive for SARS-CoV-2 and compared to a randomly selected sample of FGID who tested negative. We used multivariate logistic regression to determine risk factors for SARS-CoV-2 infection. We also evaluated healthcare utilization by comparing health care visits (ED, inpatient, outpatient), medication prescriptions, abdominal CT scans, and endoscopy rate 6 month pre pandemic and 6 months after the start of the pandemic (using 3/15/20 as a cut-off point). Results: We identified and analyzed 2592 patients with FGID who underwent SARS-CoV-2 testing (83 positive COVID-19 cases). The total positivity rate was 3.9%. Inpatient admissions (0.36 vs 0.50, p<0.001), outpatient visits (4.78 vs 5.68, p<0.001), number of abdominal CT scans (0.18 vs 0.23, p=0.002), number of upper endoscopies (0.10 vs 0.19, p<0.001), and number of colonoscopies (0.04 vs 0.10, p<0.001) were higher during the 6 months after the start of the pandemic (compared to the 6 months before). Prescription rate for PPIs, H2 blockers, opioids, and anti-platelet agents were also higher during the pandemic (Table 1). Patients had higher rates of symptoms including abdominal pain, vomiting, diarrhea, constipation, and weight loss during the pandemic, as reported by ICD coding. Similar trends were seen when stratifying by FGID type, and by SARS-CoV-2 test positivity (but did not reach statistical significance in the SARS-CoV-2 positive group. Active smoking, cough, pneumonia, and diarrhea-predominant IBS were associated with increased risk of COVID-19 among patients with FGID, while alcohol use and functional dyspepsia decreased this risk (Table 2). Discussion: Health care utilization among patients with FGIDs increased significantly during the pandemic, independent of SARS-CoV-2 positivity. Increased psychosocial stress and increased utilization of telehealth visits may partially explain this trend. Our data suggest that smoking status, cough, pneumonia, and diarrhea-predominant IBS could independently determine the increased risk of COVID-19 among patients with FGID.(Table presented)(Table presented)