While most gastrointestinal (GI) symptoms resolved for patients hospitalized with COVID-19, inability to gain weight persisted for months, researchers found in a retrospective study.

Half of all patients (50.6%) could not regain weight at 3 months, while 32.4% of patients reported an inability to gain weight 6 months later, reported Arvind J. Trindade, MD, from Long Island Jewish Medical Center in New Hyde Park, New York, and colleagues.

Percentages were higher among patients with malnutrition, with 56.4% of this population unable to gain weight at 6 months, the authors wrote in Clinical Gastroenterology and Hepatology.

However, gastroenteritis, GI bleeding, and pancreatitis resolved for most patients 3 months after illness, they noted.

“Our study provides reassurance that most individuals with the onset of GI bleeding or gastroenteritis associated with COVID-19 infection will have resolution of these symptoms,” Trindade and colleagues stated.

GI symptoms manifest in patients after the SARS-CoV-2 virus binds to the angiotensin-converting enzyme 2 (ACE2) receptor inside epithelial cells of the GI tract, the group explained. These symptoms occur in anywhere from 17.6% to 53% of COVID-19 patients, they said, with prior reports suggesting that 10.1% to 39.7% of patients experience loss of appetite.

Longer-term data on COVID-19 sequelae and its association to malnutrition has been limited, Trindade told MedPage Today. From his clinical observations, a lot of COVID-19 patients have trouble regaining weight and the reason why has been largely unknown, he added.

The current study represents the largest cohort of COVID-19 with associated GI symptoms, and included 17,462 patients admitted to a dozen New York hospitals from March 2020 to January 2021. The researchers investigated post-COVID-19 GI sequelae at 3 and 6 months after hospitalization.

Trindade’s group included adults who tested positive for SARS-CoV-2 via PCR and were hospitalized with GI symptoms, and had 3 months and/or 6 months of outpatient follow-up or were hospitalized a second time. Most had follow-up data assessed at 3 months (88.7%), but that dropped to 56.5% at 6 months. Median age of patients was 66, with 46% being Caucasian. Average length of hospital stay was 9 days. There were 14.1% who required mechanical ventilation and 14.8% were on vasopressors.

Authors reported a total of 18.5% patients had GI symptoms as a result of COVID-19. Among those cases, 22.1% had symptoms and follow-up data, and 24.4% had distinct GI manifestations. Gastroenteritis was the most common initial GI symptom (52.5%), followed by malnutrition (23%) and bleeding (20.4%).

Among the 19 patients who underwent an endoscopy for GI bleeding, 21.1% were found to have gastric and duodenal ulcers, 21.1% had gastritis or duodenitis, and 21% had normal findings.

Trindade and colleagues urged physicians to focus more specifically on COVID-19 patients who experience malnutrition during hospitalization and highlighted the urgency to develop malnutrition screening assessments for COVID-19 patients who recover from an acute infection.

Limitations of this study included the fact that only hospitalized patients were included. Therefore, the findings may not be applicable to non-hospitalized COVID-19 patients with GI symptoms. Data also only came from New York-area facilities, with a lack of follow-up beyond 6 months.

The next steps in his research could possibly look into systemic causes of GI-related symptoms in COVID-19 patients, and investigate why this is happening, said Trindade.