Impact of COVID-19 on Motility Practices: New Onset Gastrointestinal and Autonomic Dysfunction After COVID-19 and the Effects of Vaccination in a Nationwide Cohort Study

ABSTRACT

Using ICD-10 and CPT codes, patients diagnosed with COVID-19 between Jan 1 to Dec 31, 2020 were propensity score matched for risk factors to negative controls (NC), and patients diagnosed with either Influenza, Lyme’s disease (LD), Infectious Mononucleosis (IM), Herpes Zoster (HZ), Varicella Zoster (VZ) and Cytomegalovirus (CMV). A Kaplan-Meier analysis was used to estimate the hazard ratio (HR) and cumulative incidence of new-onset outcomes within 3 months and 1 year after the diagnosis of the respective health event, including GI symptoms or diagnoses, symptoms of autonomic (AN) sensory (SN), and motor (MN) neuropathy. Kaplan Meier analysis comparing new-onset outcomes between patients diagnosed with COVID-19 and a matched Influenza and negative control cohort New-onset outcomes COVID-19 vs Negative controls (n=1,889,175) COVID-19 vs Influenza (n=698,253) HR (95% CI) Probability COVID Probability NC P-value HR (95% CI) Probability COVID Probability Influenza P-value Gastrointestinal (GI) symptoms or diagnoses 1.37 (1.35 - 1.39) 11.43% 8.44% < 0.001 1.04 (1.03 - 1.06) 11.41% 10.87% < 0.001  Dysphagia 1.37 (1.33 - 1.41) 1.4% 1.03% < 0.001 1.18 (1.14 - 1.23) 1.23% 1.03% < 0.001  Gastro-esophageal reflux disease 1.30 (1.28 - 1.33) 4.21% 3.23% < 0.001 1.13 (1.11 - 1.16) 3.97% 3.5% < 0.001  Heartburn 1.15 (1.09 - 1.21) 0.42% 0.37% < 0.001 1.20 (1.12 - 1.28) 0.44% 0.36% < 0.001  Nausea 1.54 (1.50 - 1.58) 2.39% 1.56% < 0.001 1.12 (1.09 - 1.15) 2.51% 2.24% < 0.001  Vomiting 1.78 (1.71 - 1.85) 0.87% 0.49% < 0.001 1.04 (0.99 - 1.08) 0.9% 0.87% 0.116  Early satiety 1.31 (1.20 - 1.43) 0.15% 0.12% < 0.001 1.63 (1.44 - 1.85) 0.14% 0.09% < 0.001  Abdominal and pelvic pain 1.38 (1.36 - 1.41) 6.38% 4.63% < 0.001 0.97 (0.96 - 0.99) 6.62% 6.74% 0.01  Bloating 1.28 (1.24 - 1.33) 1.01% 0.78% < 0.001 1.29 (1.24 - 1.35) 0.97% 0.75% < 0.001  Gastroparesis 1.47 (1.35 - 1.60) 0.18% 0.12% < 0.001 1.39 (1.25 - 1.55) 0.17% 0.12% < 0.001  Functional dyspepsia 1.09 (1.02 - 1.17) 0.22% 0.2% 0.016 0.79 (0.73 - 0.86) 0.21% 0.27% < 0.001  Constipation 1.35 (1.32 - 1.38) 2.61% 1.94% < 0.001 1.17 (1.14 - 1.21) 2.4% 2.04% < 0.001  Diarrhea 1.53 (1.49 - 1.57) 2.62% 1.71% < 0.001 1.01 (0.98 - 1.03) 2.63% 2.61% 0.631  Irritable bowel syndrome 1.07 (1.02 - 1.12) 0.5% 0.47% 0.006 1.04 (0.98 - 1.10) 0.52% 0.5% 0.188  Inflammatory bowel disease 1.50 (1.45 - 1.56) 1.06% 0.71% < 0.001 0.75 (0.72 - 0.78) 1.05% 1.4% < 0.001 Autonomic neuropathy 1.32 (1.30 - 1.34) 8.69% 6.64% < 0.001 1.15 (1.13 - 1.17) 8.22% 7.1% < 0.001  Postural symptoms 1.43 (1.41 - 1.46) 5.89% 4.15% < 0.001 1.15 (1.13 - 1.18) 5.64% 4.88% < 0.001  Urinary dysfunction 1.22 (1.19 - 1.25) 2.76% 2.26% < 0.001 1.12 (1.09 - 1.16) 2.53% 2.24% < 0.001  Sexual dysfunction 0.99 (0.95 - 1.03) 0.66% 0.66% 0.751 1.04 (0.98 - 1.10) 0.59% 0.56% 0.168  Exocrine gland dysfunction 1.22 (1.18 - 1.26) 1.24% 1.02% < 0.001 1.26 (1.21 - 1.31) 1.17% 0.93% < 0.001 Sensory neuropathy 1.12 (1.09 - 1.15) 1.71% 1.53% < 0.001 0.89 (0.86 - 0.92) 1.69% 1.89% < 0.001 Motor neuropathy 1.22 (1.19 - 1.25) 1.52% 1.25% < 0.001 0.98 (0.95 - 1.01) 1.47% 1.49% 0.247 Outcomes are presented as a HR, in which the numerator consists of the COVID-19 population.