Two Factors Linked to Higher Risk of Long COVID in IBD

Damian McNamara, MA

February 18, 2022

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Two features are significantly associated with a higher risk for developing long COVID symptoms among people with inflammatory bowel disease (IBD), according to a large Danish population study.

People with Crohn's disease (CD) who experienced adverse acute COVID-19, defined as requiring hospitalization, were nearly three times more likely to report persistent symptoms 12 weeks after acute infection.

"Long-term, persisting symptoms following COVID-19 is a frequently occurring problem, which is probably underappreciated. IBD specialists should therefore be aware of any of these symptoms and actively ask patients whether they have these problems," lead author Mohamed Attauabi, MD, PhD, told Medscape Medical News.

Attauabi and colleagues also found that people with ulcerative colitis (UC) who discontinued immunosuppressive agents because of COVID-19 were 1.5 times more likely to experience long COVID symptoms, a result that surprised the researchers.  

"This has not been shown before and remains to be confirmed," said Attauabi, a fellow in the department of gastroenterology at Herlev Hospital at the University of Copenhagen, Denmark.

Attauabi presented the results as a digital oral presentation at the ECCO'22 Virtual Congress of the European Crohn's and Colitis Organisation (ECCO).

A Closer Look at IBD and COVID-19

Large, hospital-based studies of symptoms consistent with long COVID reveal a high prevalence of fatigue, sleep difficulties, and anxiety at 12 weeks or more post-acute infection. However, these were not specific to people with CD or UC, Attauabi said.

"In patients with IBD, the risk of long-term sequelae of COVID-19 remains to be investigated," he said.

Attauabi and colleagues studied 197 people with CD and 319 with UC, all of whom had PCR-confirmed COVID-19. Participants were prospectively enrolled in the population-based Danish IBD-COVID registry from January 28, 2020 to April 1, 2021. At a median of 5.1 months, a subset of 85 people with CD and 137 with UC agreed to report any post-COVID symptoms.

Older age, smoking, IBD disease activity, and presence of comorbidities were not associated with a significantly elevated risk of long COVID.

In a multivariate analysis, hospitalization for COVID-19 among people with CD was significantly associated with long COVID (odds ratio [OR], 2.76; 95% CI, 1.05 - 3.90; P = .04).

Furthermore, people with UC who stopped taking immunosuppressive agents also had a significantly higher risk (OR, 1.50; 95% CI, 1.07 - 10.22; P = .01).

"However, IBD medications such as systemic steroids were not associated with this outcome," Attauabi said.

Fatigue Most Common Long COVID Symptom

Fatigue was the most common long COVID symptom, reported by 37% of patients with CD and 36% with UC.

Anosmia and ageusia were also common, reported by 29% and 28% of patients with CD, and 27% and 19% of those with UC, respectively.

"In our cohort of patients with UC or CD who developed COVID-19, the long-term health effects of COVID-19 did not appear to differ among patients with UC or CD nor according to IBD medications," Attauabi said.

That is a "great study," said session co-chair Torsten Kucharzik, MD, PhD, head of internal medicine and gastroenterology at Lueneburg Hospital, Germany.

When Kucharzik asked about smoking, Attauabi responded that they collected information on current and previous smoking, but they chose not to include the data because it was not statistically significant.

Attauabi has reported no relevant financial relationships. Kucharzik has reported receiving grants from Takeda and personal fees from companies including MSD/Essex, AbbVie, Falk Foundation, Biogen, Bristol Myers Squibb, Arena, Celgene, Celltrion, Ferring, Janssen, Galapagos, Olympus, Mundipharma, Takeda, Amgen, Pfizer, Roche, and Vifor Pharma.

ECCO 2022 Congress. Presented February 17, 2022. DOP Abstract 23.

Damian McNamara is a staff journalist based in Miami. He covers a wide range of medical specialties, including infectious diseases, gastroenterology, and critical care. Follow Damian on Twitter: @MedReporter.

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