Incidence of persistent SARS-CoV-2 gut infection in patients with a history of COVID-19: Insights from endoscopic examination

Mohamed Hany; Eman Sheta; Ahmed Talha; Medhat Anwar; Mohamed Selima; Muhammad Gaballah; Ahmed Zidan; Mohamed Ibrahim; Ann Samy Shafiq Agayby; Anwar Ashraf Abouelnasr; Mohamed Samir; Bart Torensma

doi:10.1055/a-2180-9872

Endoscopy International Open, Table of Contents

CC BY 4.0 · Endosc Int Open 2024; 12(01): E11-E22
DOI: 10.1055/a-2180-9872

Original article

Incidence of persistent SARS-CoV-2 gut infection in patients with a history of COVID-19: Insights from endoscopic examination

Mohamed Hany

¹Department of Surgery, Medical Research Institute, Alexandria University, Hadara, Alexandria 21561, Egypt (Ringgold ID: RIN54562)

,

Eman Sheta

²Department of Pathology, Alexandria University, Alexandria, Egypt (Ringgold ID: RIN54562)

,

Ahmed Talha

¹Department of Surgery, Medical Research Institute, Alexandria University, Hadara, Alexandria 21561, Egypt (Ringgold ID: RIN54562)

,

Medhat Anwar

¹Department of Surgery, Medical Research Institute, Alexandria University, Hadara, Alexandria 21561, Egypt (Ringgold ID: RIN54562)

,

Mohamed Selima

¹Department of Surgery, Medical Research Institute, Alexandria University, Hadara, Alexandria 21561, Egypt (Ringgold ID: RIN54562)

,

Muhammad Gaballah

¹Department of Surgery, Medical Research Institute, Alexandria University, Hadara, Alexandria 21561, Egypt (Ringgold ID: RIN54562)

,

Ahmed Zidan

¹Department of Surgery, Medical Research Institute, Alexandria University, Hadara, Alexandria 21561, Egypt (Ringgold ID: RIN54562)

,

Mohamed Ibrahim

¹Department of Surgery, Medical Research Institute, Alexandria University, Hadara, Alexandria 21561, Egypt (Ringgold ID: RIN54562)

,

Ann Samy Shafiq Agayby

¹Department of Surgery, Medical Research Institute, Alexandria University, Hadara, Alexandria 21561, Egypt (Ringgold ID: RIN54562)

,

Anwar Ashraf Abouelnasr

¹Department of Surgery, Medical Research Institute, Alexandria University, Hadara, Alexandria 21561, Egypt (Ringgold ID: RIN54562)

,

Mohamed Samir

²Department of Pathology, Alexandria University, Alexandria, Egypt (Ringgold ID: RIN54562)

,

Bart Torensma

³Epidemiology, Leiden University Medical Center, Leiden, Netherlands (Ringgold ID: RIN4501)

› Author Affiliations

Abstract

Background and study aims Gut infection is common during acute COVID-19, and persistent SARS-CoV-2 gut infection has been reported months after the initial infection, potentially linked to long-COVID syndrome. This study tested the incidence of persistent gut infection in patients with a history of COVID-19 undergoing endoscopic examination.

Patients and methods Endoscopic biopsies were prospectively collected from patients with previous COVID-19 infection undergoing upper or lower gastrointestinal endoscopy (UGE or LGE). Immunohistochemistry was used to detect the presence of persistent SARS-CoV-2 nucleocapsid proteins.

Results A total of 166 UGEs and 83 LGE were analyzed. No significant differences were observed between patients with positive and negative immunostaining regarding the number of previous COVID-19 infections, time since the last infection, symptoms, or vaccination status. The incidence of positive immunostaining was significantly higher in UGE biopsies than in LGE biopsies (37.34% vs. 16.87%, P=0.002). Smokers showed a significantly higher incidence of positive immunostaining in the overall cohort and UGE and LGE subgroups (P <0.001). Diabetic patients exhibited a significantly higher incidence in the overall cohort (P=0.002) and UGE subgroup (P=0.022), with a similar trend observed in the LGE subgroup (P=0.055).

Conclusions Gut mucosal tissues can act as a long-term reservoir for SARS-CoV-2, retaining viral particles for months following the primary COVID-19 infection. Smokers and individuals with diabetes may be at an increased risk of persistent viral gut infection. These findings provide insights into the dynamics of SARS-CoV-2 infection in the gut and have implications for further research.

Keywords

Endoscopy Upper GI Tract - Epidemiology

Full Text

References

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