Functional Gastrointestinal And Somatoform Symptoms Five Months After Sars-Cov-2 Infection: A Controlled Cohort Study

ABSTRACT

Background and aim: Gastrointestinal infections represent a risk factor for functional gastrointestinal and somatoform extraintesti-nal disorders. We investigated the prevalence and relative risk (RR) of gastrointestinal and somatoform symptoms five months after SARS-CoV-2 infection compared with a control cohort. Materials and methods: 378 subjects, age range 18-60 years, were stu-died. 177 SARS-CoV-2 infected patients and 201 controls responded to an online questionnaire about symptoms and signs during the acute phase of the infection and after 4.8±0.3 months. 13 and 18 patients were respectively excluded because of a previous gastrointestinal dise-ase. Presence and severity of gastrointestinal symptoms, somatization, anxiety and depression were recorded with a structured standardized questionnaire, including the Structured Assessment of Gastrointestinal Symptoms (SAGIS) questionnaire, the Symptom Check List (SCL)-12 for somatization and the Hospital Anxiety and Depression Scale (HADS). Stool form through Bristol Stool scale and a yes/no question summari-zing the Rome IV criteria for Irritable Bowel Syndrome (IBS) were also recorded. Any association between exposure to infection and symp-toms was evaluated by calculating crude and adjusted RR values and score differences with 95% confidence intervals (CI). Results: Fever, dyspnea, loss of smell/taste/weight, diarrhea, myal-gia, arthralgia and asthenia were reported by more than 40% of patients during the acute phase. Abdominal pain/discomfort, diar-rhea/incontinence and gastroesophageal reflux disease/regurgita-tion symptoms persisted after SARS-CoV-2 infection, but with very low severity;the relative increase on the mean score of each domain was minimal (score difference up to +0.16). Compared with con-trols, adjusted RRs for loose stools, chronic fatigue and somatization were increased after infection 1.88 (95% CI 0.99–3.54), 2.24 (95% CI 1.48–3.37), 3.62 (95% CI 1.01–6.23) respectively. The prevalence of IBS and HADS scores tended to be greater in patients than in con-trols. Gastrointestinal sequelae were greater in patients with diar-rhea during the acute phase. Conclusions: Mild gastroenterological symptoms persist five months after SARS-CoV-2 infection, in particular in patients report-ing diarrhea in the acute phase. Infected patients are at increased risk of chronic fatigue and somatoform disorders, thus supporting the hypothesis that both functional gastrointestinal and somato-form disorders may have a common biological orig