New GI symptoms do not link to increased risk for death in IBD, COVID-19
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New gastrointestinal symptoms among patients with inflammatory bowel disease and COVID-19 did not correlate with an increased risk for death.
“A prior meta-analysis suggested that up to 17.6% of COVID-19 patients have GI symptoms. Data are conflicting on the association of GI symptoms with COVID-19 outcomes, with some reports suggesting worse prognosis among those with GI symptoms while others finding improved outcomes,” Ryan C. Ungaro, MD, MS, Icahn School of Medicine, and colleagues wrote in Inflammatory Bowel Diseases. “There are limited data on COVID-19 and GI symptoms among IBD patients.”
To describe how new onset GI symptoms associated with clinical outcomes among patients with IBD who developed COVID-19, researchers analyzed patients from the Surveillance Epidemiology of Coronavirus Under Research Exclusion for IBD database. Among 2,917 identified patients with IBD and COVID-19, 26.2% experienced new GI symptoms; the most common symptoms were diarrhea (80%) and abdominal pain (34%). Though new GI symptoms were frequently observed among patients in remission, they were more common among patients with active disease (23.3% vs. 29.4%). Further analysis demonstrated patients with IBD and new GI symptoms were more likely to be hospitalized (31.4% vs. 19.2%) while less likely to require intensive care (5.8% vs. 4.6%). New onset GI symptoms did not significantly correlate with the risk for death due to COVID-19 (adjusted OR = 0.72; 95% CI, 0.38-1.36).
“New GI symptoms are common in IBD patients with COVID-19 and are not associated with an increased risk of death due to COVID-19. Our findings suggest that an increase in GI symptoms in IBD patients should prompt consideration of a COVID-19 diagnosis,” Ungaro and colleagues concluded. “Further studies are needed to understand if GI symptoms impact COVID-19 prognosis and if COVID-19 can trigger IBD flares or alter subsequent disease course.”
Perspective
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Sara El Ouali, MD
Although patients with IBD do not have an overall increased risk for SARS-CoV-2 infection and poor outcomes, we are learning that COVID-19 manifestations in IBD may be different than in the general population. Several studies have now shown that patients with IBD more commonly present with GI symptoms than the average population. This is important information as patients with IBD and COVID-19 could present with symptoms suggestive of a flare and there should therefore be a high index of suspicion of COVID-19 in such cases.
What is not clear, however, is whether the presence of GI symptoms with COVID-19 is associated with worse outcomes, including among patients with IBD. The study presented here out of the large, international SECURE-IBD database confirms the common occurrence of GI symptoms among patients with IBD and COVID-19, but also adds new valuable prognostic information. Although patients with IBD and GI symptoms were more likely to be hospitalized than patients without GI symptoms, there was no increased risk for ICU admission or death.
More studies are needed to understand the impact of COVID-19 GI manifestations in IBD patients, but also in the general population. In the meantime, while these data are reassuring, we should continue to encourage general preventive measures and COVID-19 vaccinations among our patients with IBD.
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