A recent survey showed that prolonged COVID gastrointestinal (GI) symptoms are associated with mental health symptoms, and a more severe illness doubled the risk of post-COVID GI symptoms.

The survey covered 749 patients who had tested positive for COVID-19 at the Columbia University Irving Medical Center from April to November 2020 and had recovered from the infection. The minimum follow-up period was 6 months. Women comprised 67%; 15% were admitted to hospital and 1.7% required mechanical ventilation.

Of the 749 patients, 220 (29%) reported COVID-related GI symptoms: heartburn (16%), constipation (11%), diarrhea (9.6%), abdominal pain (9.4%), and nausea or vomiting (7%).

Pre-COVID mental health symptoms were reported by 39 patients (5%), while post-COVID mental health symptoms, most commonly anxiety and sadness, were reported by as many as 280 patients (37%).

The probability of having GI symptoms was higher in those who had pre-COVID mental health symptoms: 49% vs. 28%, respectively. Those who developed mental health symptoms after COVID were more likely to also have GI symptoms post-COVID: 55% with sadness or anxiety vs. 14%.

Patients who had severe COVID and required hospitalization were more prone to have post-COVID GI symptoms compared to those who were not hospitalized: 51% vs. 26%, respectively.

Thirteen of the 33 patients with abdominal pain met the Rome IV criteria for irritable bowel syndrome (IBS) after reporting weekly pain and change in stool form or frequency for a minimum of 6 months.

Patients with mental health symptoms either before or after COVID were more likely to report post-COVID GI symptoms. Increasing severity of GI symptoms was associated with higher risk for new anxiety or sadness.

These survey findings, published in the journal Gastroenterology, highlight the strong association between mental health symptoms and post-COVID symptoms; 11% patients surveyed described their GI symptom as the “most bothersome current symptom”.

Feeling anxious or sad may aggravate functional GI disorders such as IBS, the symptoms of which in turn may add to the anxiety or sadness. Hence, physicians treating GI symptoms in patients with prolonged COVID should also screen them for anxiety and other mental health symptoms.

Reference1. Blackett JW, et al. Potential long COVID-19 gastrointestinal symptoms 6 months after coronavirus infection are associated with mental health symptoms. Gastroenterology 2021; DOI: 10.1053/j.gastro.2021.10.040.