Viruses. 2023 Jul 26;15(8):1625. doi: 10.3390/v15081625.

Michael J Hawkings ^1 2, Natasha Marcella Vaselli ^2 3, Dimitrios Charalampopoulos ¹, Liam Brierley ⁴, Alex J Elliot ^2 5, Iain Buchan ^1 2, Daniel Hungerford ^2 3

Author information

¹Department of Public Health, Policy & Systems, Institute of Population Health, University of Liverpool, Liverpool L69 3GF, UK.

²National Institute for Health and Care Research Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool L69 7BE, UK.

³Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool L69 7BE, UK.

⁴Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool L69 3GF, UK.

⁵Real-Time Syndromic Surveillance Team, Field Services, Health Protection Operations, UK Health Security Agency, Birmingham B2 4BH, UK.

Abstract

It is known that SARS-CoV-2 infection can result in gastrointestinal symptoms. For some, these symptoms may persist beyond acute infection, in what is known as 'post-COVID syndrome'. We conducted a systematic review to examine the prevalence of persistent gastrointestinal symptoms and the incidence of new gastrointestinal illnesses following acute SARS-CoV-2 infection. We searched the scientific literature using MedLine, SCOPUS, Europe PubMed Central and medRxiv from December 2019 to July 2023. Two reviewers independently identified 45 eligible articles, which followed participants for various gastrointestinal outcomes after acute SARS-CoV-2 infection. The study quality was assessed using the Joanna Briggs Institute Critical Appraisal Tools. The weighted pooled prevalence for persistent gastrointestinal symptoms of any nature and duration was 10.8% compared with 4.9% in healthy controls. For seven studies at low risk of methodological bias, the symptom prevalence ranged from 0.2% to 24.1%, with a median follow-up time of 18 weeks. We also identified a higher risk for future illnesses such as irritable bowel syndrome, dyspepsia, hepatic and biliary disease, liver disease and autoimmune-mediated illnesses such as inflammatory bowel disease and coeliac disease in historically SARS-CoV-2-exposed individuals. Our review has shown that, from a limited pool of mostly low-quality studies, previous SARS-CoV-2 exposure may be associated with ongoing gastrointestinal symptoms and the development of functional gastrointestinal illness. Furthermore, we show the need for high-quality research to better understand the SARS-CoV-2 association with gastrointestinal illness, particularly as population exposure to enteric infections returns to pre-COVID-19-restriction levels.