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Ashktorab H, Challa SR, Singh G, Nanduri S, Ibrahim M, Martirosyan Z, Whitsell P, Chirumamilla LG, Shayegh N, Watson K, Smith T, Ogwo V, Kolawole O, Littleton M, Morrison N, Nair V, Byer D, Dawodu DO, Lexima P, Rashid M, Deverapalli M, Atluri SM, Nezamloo A, Nasrin F, Kim RJA, Sherif Z, Oskrochi G, Carethers JM, Brim H. Gastrointestinal Manifestations and Their Association with Neurologic and Sleep Problems in Long COVID-19 Minority Patients: A Prospective Follow-Up Study. Dig Dis Sci 2024; 69:562-569. [PMID: 38135813 DOI: 10.1007/s10620-023-08176-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/29/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Long-COVID is a condition post SARS-CoV-2 infection with persistent or recurring symptoms affecting multiple organs, and may involve viral persistence, changes to the microbiome, coagulopathies, and alterations to neuro-immune interactions. These factors can disrupt the Gut-Brain Axis, which is a complex system involving bidirectional communication between the central nervous system and the gastrointestinal (GI) system. As a result of these disruptions, individuals with long-COVID may develop post-infectious functional GI disorders, which can cause a range of symptoms affecting the digestive system. AIM To understand frequency of GI manifestations of Long-COVID and to determine association with sleep or neurological symptoms in a predominantly minority population. METHODS We included patients with positive SARS-CoV-2 PCR (n = 747) who were hospitalized from Feb. 2020 to May 2021 at Howard University Hospital and followed between 6 and 12 months from discharge. GI, sleep, and neurological symptoms (via the Montreal Cognitive Assessment (MoCA) scoring system) were assessed using a standardized questionnaire. Linear regression analysis, χ2 and Fisher's exact test were utilized to determine the statistical significance of correlations of GI/Neuro/COVID. RESULTS The mean age of patients was 58, with 51.6% females and a predominant African American ethnicity (73.6%, n = 550). A total of 108 patients died during their initial hospital stay, with the remaining 639 patients followed-up. Three hundred fifty (350) patients responded to the questionnaire (57 patients died during the follow-up period). Overall, 39 (13.3%) patients reported GI-related symptoms, out of which 19 (6.4%) had persistent symptoms and 20 (6.8%) developed new onset GI symptoms. Nausea and vomiting were the most common 24/39 (61.5%), followed by abdominal pain 7/39 (18%), diarrhea 5/39 (12.8%), and others 3/39 (7.6%). Patients who presented with vomiting during acute SARS-CoV-2 infection were more likely to have Long-COVID GI manifestations (P = 0.023). Use of ACE inhibitors, abnormal lymphocyte count and elevated ferritin are other variables that showed significant associations with Long-COVID GI manifestations (P = 0.03, 0.006 and 0.03, respectively). During follow-up, a total of 28 (9.5%) patients reported difficulty with sleep and 79 (27%) patients had abnormal MoCA assessment. With further analysis, there was a trend between presentation of GI symptoms on admission with abnormal MoCA assessment, and an association between abnormal LFTs and history of liver disease during hospitalization with subsequent sleep problems. Baseline characteristics, clinical comorbidities, other laboratory values, hospital length of stay, mechanical ventilation, medications during hospitalization, re-admission and Flu or COVID-19 vaccination have not shown any association with Long-COVID GI symptoms in our cohort. CONCLUSION Dyspeptic symptoms were common GI manifestations in the acute and post COVID periods. GI symptoms, abnormal LFTs and a history of liver disease during the acute infectious phase associates with abnormal MoCA and sleep problems during follow-up. Further large population studies are needed to determine if COVID-19 leads to a GI symptoms-associated Long-COVID phenotypes and other symptoms through the Gut-Brain-Axis.
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Affiliation(s)
- Hassan Ashktorab
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA.
- Howard University College of Medicine, 2041 Georgia Avenue, N.W., Washington, DC, 20060, USA.
| | | | - Gagan Singh
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Sumant Nanduri
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Malika Ibrahim
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Zara Martirosyan
- Howard University College of Medicine, 2041 Georgia Avenue, N.W., Washington, DC, 20060, USA
| | - Peter Whitsell
- Howard University College of Medicine, 2041 Georgia Avenue, N.W., Washington, DC, 20060, USA
| | - Lakshmi G Chirumamilla
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Nader Shayegh
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Kyra Watson
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Tori Smith
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Valarie Ogwo
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
- Department of Biochemistry & Molecular Biology, Howard University College of Medicine, Washington, DC, USA
- College of Engineering and Technology, American University of the Middle East, Egaila, Kuwait
- Division of Gastroenterology & Hepatology, Department of Medicine and Moores Cancer Center, UC San Diego, San Diego, USA
- Department of Pathology and Cancer Center, Howard University College of Medicine, Washington, DC, USA
- Department of Pathology and Cancer Center, Howard University College of Medicine, Washington, DC, USA
| | - Oluwapelumi Kolawole
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Megan Littleton
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Nicole Morrison
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Vaisakh Nair
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Danae Byer
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Dideolu O Dawodu
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Patrice Lexima
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Mudasir Rashid
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Mrinalini Deverapalli
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Swetha Mynedi Atluri
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Ali Nezamloo
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Farjana Nasrin
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Rachel Ji-Aeh Kim
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Zaki Sherif
- Department of Biochemistry & Molecular Biology, Howard University College of Medicine, Washington, DC, USA
| | - Gholamreza Oskrochi
- College of Engineering and Technology, American University of the Middle East, Egaila, Kuwait
| | - John M Carethers
- Division of Gastroenterology & Hepatology, Department of Medicine and Moores Cancer Center, UC San Diego, San Diego, USA
| | - H Brim
- Department of Pathology and Cancer Center, Howard University College of Medicine, Washington, DC, USA
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