A study concerning the affect of Covid-19 on gastro-intestinal (GI) tract, liver and pancreas, conducted on 222 Covid-19 patients admitted at PGIMER over the past three-month, concluded that at least one GI symptom was found in 60 patients– making up 27 per cent of the total participants.
Regarding the purpose of the study, PGIMER’s Head of Department of Gastroenterology, Professor Rakesh Kochhar says, “While the virus was initially thought to be a respiratory pathogen, the extra-pulmonary effects of the virus and the mode of transmission have gained limelight and we wanted to understand this further.”
The study was conducted by Dr Seerat under the guidance of Dr Jayanta Samanta, Dr Ashish Bhalla and Dr Rakesh Kochhar.
Nausea, vomiting, diarrhoea, loss of appetite, pain in abdomen, abdominal discomfort, loss of taste and smell constitute the various GI symptoms being experienced by Covid-19 patients. Among the 60 patients in whom at least one GI symptom was found, 46 had GI symptoms along with other symptoms. Over the course of illness, 152 patients (68.4 per cent) developed GI symptoms and 30 patients (13.5 per cent) had only GI manifestation without any respiratory symptoms.
Among GI manifestations, diarrhoea was the most common symptom (30.2 per cent), followed by loss of appetite (29.3 per cent) and loss of taste (26.6 per cent). Of the total observed cases, pre-existing GI diseases such as chronic liver disease, pancreatitis and liver abscess, among others, were noted in 19 patients (7.7 per cent).
“The study strives to bring forward the point that people may not have common symptoms like sore throat, cough, cold, body ache etc, and instead may suffer from GI symptoms if they have coronavirus, as the investigation indicates,” says Dr Kochhar.
The GI symptoms were higher in patients with more severe Covid-19 disease as compared to those with mild infection. Patients with GI symptoms had higher tendency to be admitted in the ICU, while patients who did not survive had more chances of having concomitant GI symptoms (64.3 per cent against 35.7 per cent).
The doctor says that the medicines used for treatment of Covid-19 may also induce GI symptoms, and that’s an aspect that has been looked at as a part of the study. Another interesting finding was the degree of pancreatic injury as seen by elevation of either amylase or lipase, which are markers of pancreatic injury.
The Covid-19 patients who did not have clinical pancreatitis also showed raised amylase and lipase levels, suggestive of pancreatic injury. The department had earlier published a review on this phenomenon of pancreatic injury noted in patients of Covid-19.
“In this study, we found that amylase was high in 47 (21.17 per cent) patients and lipase was high in 78 (34.68 per cent) patients, five and seven out of these had levels more than three times the upper limit of the normal, respectively. Patients who had GI symptoms or severe disease had higher chances of increased amylase/lipase levels.
The study is on-going, as the patients are being followed to see whether the GI symptoms resolve or resist, “We have framed a questionnaire that intends to understand how three months after discharge if the patients are facing any symptoms and if the quality of life has been affected after Covid-19,” says Dr Kochhar.
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