Rossanun Shoosanglertwijit1, Panyavee Pitisuttithum2,4, Tanisa Patcharatrakul3,4, Sutep Gonlachanvit3,4, Opass Putcharoen5

1Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand, 2Division of General Internal Medicine, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand, 3Division of Gastroenterology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand,4Center of Excellence in Neurogastroenterology and Motility, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, 5Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Thai Red Cross Emerging Infectious Diseases Clinical Centre, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand.

Background/Aims: SARS-CoV-2 shedding in feces has been reported. We aimed to find: (1)The predictors of fecal viral shedding, (2)Incidence of post-infectious FGIDs.

Methods: 188 COVID-19 patients admitted from March to July 2020 were included and prospectively collected the stool samples on admission date and then weekly until negative results. Patients were followed regarding their GI symptoms for 6 months to diagnose post COVID-19 irritable bowel syndrome (IBS), functional constipation (FC), and functional dyspepsia (FD) by using Rome IV criteria.

Results: 85 patients (66.9%) had positive stool SARS-CoV-2 with a duration of viral shedding of 79 (76-90) days. Disease severity, presence of pneumonia, fever, respiratory symptoms, vomiting, and diarrhea were not significantly different between patients with and without fecal viral shedding. Patients with stool shedding had higher prevalence of anosmia [5(83.3%) vs 0, p=0.048], lower absolute lymphocyte [1.42(0.96-1.77) x109/L vs 1.84(1.27-2.17) x109/L, p=0.004], higher ALT [27(18.25-36.75) U/L vs 19(13-28.5) U/L, p=0.02] and lower cycle threshold values [19.68 (16.35-26.40) vs 26.28 (19.34-33.31), p=0.05] (table1). 87 patients completed 6-month follow-up. 8 patients (9.2%) had new onset of GI symptoms during 6-month post COVID-19 infection [early satiety (n=7), constipation (n=3) and abdominal pain (n=2) with median severity: 5.5 (1-6) of 10]. Two patients (2.3%) had FD, and 1 patients (1.1%) had FC. No IBS was diagnosed.

Conclusion: Most COVID-19 patients had viral shedding in stool for up to 3 months. Some clinical and laboratory results were associated with fecal viral shedding but not the GI symptoms during admission. Post-infectious functional GI disorders were uncommon.

Keywords: COVID-19, SARS-CoV-2, Thailand, stool PCR, stool shedding