Increased Risk of Gastroparesis Following COVID-19: A Comprehensive Analysis Using a Large-Scale Database

SARS-CoV-2, the virus responsible for COVID-19, has been recognized for its diverse clinical manifestations, with gastrointestinal (GI) symptoms often preceding respiratory signs. These symptoms encompass loss of appetite, diarrhea, nausea, vomiting, and abdominal pain.

While isolated case reports document the occurrence of gastroparesis post-COVID-19, a thorough exploration on a large scale is currently lacking. To bridge this gap, our study aimed to investigate the risk of gastroparesis following COVID-19 using extensive data from the TriNetX multi-institutional database.

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TEABLE 1

Gastroparesis is a medical condition that affects the normal spontaneous movement of the muscles (motility) in the stomach. The term “gastroparesis” is derived from the Greek words “gastro,” meaning stomach, and “paresis,” meaning partial paralysis. In essence, it refers to a partial paralysis or impairment of the stomach muscles, leading to delayed emptying of food from the stomach into the small intestine.

Causes:

• Diabetes Mellitus: The most common cause of gastroparesis is diabetes mellitus, particularly when it is poorly controlled. High blood sugar levels over time can damage the nerves that control the stomach muscles.
• Post-Surgical Complications: Surgeries involving the stomach or related organs may lead to damage or disruption of the vagus nerve, which plays a crucial role in stomach motility.
• Viral Infections: Certain viral infections, such as herpes simplex virus or cytomegalovirus, can affect the nerves of the stomach.
• Medications: Some medications, particularly those that affect the nervous system, can contribute to gastroparesis. Examples include certain antidepressants and drugs used to treat Parkinson’s disease.
• Idiopathic: In some cases, the exact cause of gastroparesis may not be identified, leading to a diagnosis of idiopathic gastroparesis.

Symptoms:

• Nausea and Vomiting: Delayed stomach emptying can cause a feeling of fullness and lead to nausea and vomiting.
• Abdominal Pain: Some individuals with gastroparesis experience abdominal discomfort or pain.
• Weight Loss: Due to difficulty in consuming an adequate amount of food, unintentional weight loss is a common symptom.
• Fluctuating Blood Sugar Levels: In diabetic patients, gastroparesis can make it challenging to control blood sugar levels because the absorption of food is delayed.
• Heartburn or Acid Reflux: The delayed emptying of the stomach can result in the backup of stomach acid into the esophagus, causing heartburn or acid reflux.

Diagnosis:

• Medical History and Physical Examination: A healthcare provider will review the patient’s medical history, symptoms, and conduct a physical examination.
• Blood Tests: Blood tests may be conducted to check for conditions such as diabetes or electrolyte imbalances.
• Imaging Studies: Various imaging studies, such as a gastric emptying study, may be performed to assess the rate at which food moves through the stomach.
• Endoscopy: An endoscopy may be performed to rule out other gastrointestinal issues and to visually inspect the stomach lining.

Treatment:

• Dietary Modifications: Patients with gastroparesis are often advised to modify their diet by consuming smaller, more frequent meals and avoiding foods that are difficult to digest.
• Medications: Prokinetic medications, such as metoclopramide, may be prescribed to stimulate stomach motility.
• Nutritional Support: In severe cases, when oral intake is insufficient, nutritional support may be provided through a feeding tube.
• Botulinum Toxin Injections: In some cases, injections of botulinum toxin may be used to relax the pyloric sphincter, facilitating the passage of food from the stomach.
• Surgery: In extreme cases, surgical procedures such as gastric electrical stimulation or pyloric surgery may be considered.

Complications:

• Malnutrition: Delayed stomach emptying can lead to malnutrition due to inadequate nutrient absorption.
• Dehydration: Persistent vomiting and inadequate fluid intake can result in dehydration.
• Fluctuations in Blood Sugar: In diabetic patients, gastroparesis can make blood sugar management challenging.
• Impaired Quality of Life: The chronic nature of gastroparesis and its symptoms can significantly impact a patient’s quality of life.

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Methods:

Utilizing the TriNetX database, we conducted an in-depth analysis on the risk of newly diagnosed gastroparesis (ICD-10 code K31.84) in adult patients aged 18 to 65 who had experienced COVID-19 between April 2020 and December 2021. A comparative analysis was performed with patients who had other viral respiratory infections (VRI) excluding COVID-19. Patients with a history of bariatric surgery or pre-existing gastroparesis were excluded. To ensure comparability, we employed 1:1 propensity score matching for variables including age, sex, race, ethnicity, diabetes mellitus, opioid use, fundoplication, and hospitalizations.

Results:

Throughout the study period, a total of 5,566,643 patients were diagnosed with COVID-19 (57% female, 61% white) and 499,709 patients with other VRI (64% female, 65% white). Following propensity score matching, both cohorts consisted of 499,718 patients each. The analysis revealed that patients with COVID-19 exhibited a significantly higher risk of newly diagnosed gastroparesis compared to those with other VRI at multiple time intervals post the index event. The odds ratios (OR) and 95% confidence intervals (CI) were as follows: 1 month (OR 4.00, 95% CI 2.77-5.76, P < 0.0001), 3 months (OR 2.66, 95% CI 2.11-3.36, P < 0.0001), 6 months (OR 2.26, 95% CI 1.89-2.71, P < 0.0001), and 12 months (OR 1.90, 95% CI 1.67-2.18, P < 0.0001) after COVID-19 infection (Table 1).

Conclusion:

Our comprehensive analysis suggests that individuals with COVID-19 face a heightened risk of developing new-onset gastroparesis compared to those with other viral respiratory infections. While viral infections have previously been associated with the onset of gastroparesis, our study emphasizes an elevated risk among COVID-19 patients, raising concerns about potential long-term complications post-infection. Notably, the increased risk appears to decrease over time.

Consequently, our findings advocate for prolonged monitoring and management of gastrointestinal symptoms in COVID-19 patients. Further research is imperative to validate these results and delve into the underlying mechanisms triggering gastroparesis in the context of COVID-19.

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reference link : https://journals.lww.com/ajg/fulltext/2023/10001/s1854_temporal_trends_in_the_risk_of_new_onset.2195.aspx