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Functional gastrointestinal and somatoform symptoms five months after SARS-CoV-2 infection: A controlled cohort study (2021) Noviello et al

Discussion in 'Long Covid research' started by Milo, Jun 2, 2021.

  1. Milo

    Milo Senior Member (Voting Rights)

    Messages:
    2,107
    Not a recommendation.

    Functional gastrointestinal and somatoform symptoms five months after SARS-CoV-2 infection: A controlled cohort study

    Link to full text here

    Abstract
    Background
    Gastrointestinal infections represent a risk factor for functional gastrointestinal and somatoform extraintestinal disorders. We investigated the prevalence and relative risk (RR) of gastrointestinal and somatoform symptoms 5 months after SARS-CoV-2 infection compared with a control cohort.

    Methods
    One hundred and sixty-four SARS-CoV-2 infected patients and 183 controls responded to an online questionnaire about symptoms and signs during the acute phase of the infection and after 4.8 ± 0.3 months. Presence and severity of gastrointestinal symptoms, somatization, anxiety, and depression were recorded with standardized questionnaires. Stool form and presence of irritable bowel syndrome (IBS) were also recorded. Any association between exposure to infection and symptoms was evaluated by calculating crude and adjusted RR values and score differences with 95% confidence intervals (CI).

    Key Results
    Fever, dyspnea, loss of smell/taste/weight, diarrhea, myalgia, arthralgia, and asthenia were reported by more than 40% of patients during the acute phase. Compared with controls, adjusted RRs for loose stools, chronic fatigue, and somatization were increased after infection: 1.88 (95% CI 0.99–3.54), 2.24 (95% CI 1.48–3.37), and 3.62 (95% CI 1.01–6.23), respectively. Gastrointestinal sequelae were greater in patients with diarrhea during the acute phase.

    Conclusions & Inferences
    Mild gastroenterological symptoms persist 5 months after SARS-CoV-2 infection, in particular in patients reporting diarrhea in the acute phase. Infected patients are at increased risk of chronic fatigue and somatoform disorders, thus supporting the hypothesis that both functional gastrointestinal and somatoform disorders may have a common biological origin.


    Key Points


    • Gastrointestinal infections represent a risk factor for functional gastrointestinal and somatoform extraintestinal disorders.
    • Mild gastrointestinal symptoms persist 5 months after severe acute respiratory syndrome coronavirus-2 infection together with an increased risk of chronic fatigue and somatoform symptoms.
    • Our results support the hypothesis that both functional gastrointestinal and somatoform disorders may have a common biological origin.
     
  2. Andy

    Andy Committee Member

    Messages:
    21,810
    Location:
    Hampshire, UK
    From the paper, my bolding.
    "Fatigue is reported during acute viral infections and is known to persist after the resolution of infection with several different viral and non-viral pathogens.22 The risk of chronic fatigue increases threefold after Giardia infection19 and, in a population-based analysis, it increased 1.35- to 1.82-fold after a previous gastrointestinal infection.21 Our results indicate that SARS-CoV-2 infection elevates the risk of chronic fatigue more than two times according to a recent large Chinese cohort study13 and with the reports of severe cases of chronic fatigue syndrome/myalgic encephalomyelitis described after SARS infection in the earlier coronavirus epidemics.35, 36 In line with the increased risk in chronic fatigue, the scores for somatization were higher in our patients following their SARS-CoV-2 infection than in control subjects both at univariate and multivariable analysis."
     
  3. Arnie Pye

    Arnie Pye Senior Member (Voting Rights)

    Messages:
    6,048
    Location:
    UK
    I was feeling masochistic so I started reading the full text. Like so many of these kinds of papers it declares that the disorders being studied are functional and somatoform without explaining how they arrived at this conclusion. Testing appears to have been solely by questionnaire. Just to pick a couple of fairly common GI conditions at random, how can one diagnose Coeliac Disease or a Giardia infection with a questionnaire?

    My brief flight into masochism didn't last long - I gave up very quickly.
     
    Mithriel, alktipping, Wyva and 8 others like this.
  4. Milo

    Milo Senior Member (Voting Rights)

    Messages:
    2,107
    I take offence with the language they chose and perhaps with the choice of questionnaires- though i haven’t delved into the paper.
    ‘Somatization’ and ‘’functional’ are used for ‘all in your head’- so they seem to sway between ‘all in your head’ and ‘possibly, maybe organic’. For a busy doctor who would not read the paper and only rely on the abstract, reading somatization and functional disorder is highly likely to make them jump to conclusions that are very unfortunate.
     
    alktipping, Wyva, Michelle and 7 others like this.
  5. Sean

    Sean Moderator Staff Member

    Messages:
    7,044
    Location:
    Australia
    "the scores for somatization"

    'the scores for our definition of somatization'
     
    alktipping, Wyva, Michelle and 6 others like this.
  6. Peter Trewhitt

    Peter Trewhitt Senior Member (Voting Rights)

    Messages:
    3,637
    Are these authors working on the principle that if a symptom persists beyond any acute condition after the end of the initial cause, eg an active viral or bacterial infection, it is by definition ‘functional’ or ‘somataform’? Certainly they do not seem to think that an initial biomedical trigger for the symptoms raises questions about the appropriateness of labelling the ongoing symptoms ‘functional’ or ‘somataform’.

    Both these terms, functional and somataform, in this context, are problematic in that even when they are intended as neutral terms they go from ‘no biomedical cause having been so far identified’ to asserting ‘there is no biomedical cause’, a logically dubious step. Why do the authors, who have identified initial biomedical triggers for their symptoms, not then consider the option there is some ongoing biological process? Further these terms are often not used as neutral descriptors but as euphemisms for ‘psychogenic’ which is yet another logically unjustified step.

    If it is the case that any persisting symptom is ‘functional’ or ‘somataform’, does this mean that baldness in some circumstances, the ongoing absence of an amputated limb or the increased risk of cardiovascular events following Covid-19 are ‘functional’ or ‘somataform’. For me this would make the terms in their neutral descriptive sense meaningless, and in their psychogenic sense nonsensical.

    It seems to me that people advocating the use of these terms have selected an arbitrary set of symptoms from the much larger potential symptom pool, and the interesting question is why do these researchers choose to limit their curiosity in relation to these symptoms, even when their own research, as with the current study, indicates important lines of enquiry.
     
    Mithriel, alktipping, Wyva and 5 others like this.
  7. rvallee

    rvallee Senior Member (Voting Rights)

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    12,299
    Location:
    Canada
    What this obviously shows is that "somatization" is determined entirely by medical professionals' interpretation, in a process that is no more expert or scientific than how the Catholic church determines a "miracle". By far the simplest logical explanation is that infections cause those symptoms, Occam's razor works. But they add on their predetermined interpretation, the very leading starting point, and basically write speculative fiction to support the predetermined conclusion.

    This is genuinely "doesn't look like anything to me" Westworld robots level of inability to distinguish reality from programmed fiction. It's advanced inability to learn from experience, a very different challenge from memorizing textbooks.
     
    J.G, Missense, Art Vandelay and 5 others like this.
  8. Mithriel

    Mithriel Senior Member (Voting Rights)

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    Do they actually listen to themselves? That sentence makes no sense. Infections represent risk factors for damage to the body. You get polio, it damages the body, you need calipers to walk or an iron lung to breath; there is not a point where the body heals and you start imagining you are unable to breath.

    It can be even simpler with gastointestinal problems as we know the function of the gut is strongly influenced by which microbes are present. If the useful ones are destroyed by the infection it could take years to build up a healthy population again.
     
    Peter Trewhitt, Arnie Pye and rvallee like this.
  9. dave30th

    dave30th Senior Member (Voting Rights)

    Messages:
    2,182
    This seems to be what they're saying, yes.
     

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