{ "abstract": "Background\n\nCOVID-19 is associated with higher rates of gastrointestinal diseases, although the duration of this effect and the roles of vaccination and COVID-19 severity remain uncertain.Objective\n\nTo investigate the relationship between COVID-19 and gastrointestinal diseases by vaccination status in hospitalised and non-hospitalised patients.Design\n\nWith NHS England approval, OpenSAFELY-TPP was used to access linked data from 24 million English adults. We defined three cohorts: 'prevaccination' (January 2020-June 2021), 'vaccinated' and 'unvaccinated' (June-December 2021). We estimated adjusted HRs (aHRs) comparing the incidence of 10 gastrointestinal diseases, including upper and lower gastrointestinal bleeding, after vs before or without a COVID-19 diagnosis overall and by COVID-19 severity.Results\n\nCOVID-19 diagnosis was associated with elevated incidence of gastrointestinal diseases, particularly after hospitalised disease. In the prevaccination cohort (n=18 422 781), the aHRs for upper gastrointestinal bleeding after hospitalised COVID-19 were 20.1 (95% CI 18.4 to 22.1) in weeks 1-4 and 1.90 (1.63 to 2.22) in weeks 53-102. The corresponding aHRs after non-hospitalised COVID-19 were 1.92 (1.74 to 2.11) and 1.34 (1.23 to 1.45), respectively. Across time periods, aHRs for gastrointestinal diseases were lower in vaccinated (n=14 948 727) than in unvaccinated (n=3 479 043) individuals. These patterns were similar across gastrointestinal diseases.Conclusion\n\nThe incidence of gastrointestinal disease is elevated for up to 2 years among individuals hospitalised following a COVID-19 diagnosis, especially in the first few weeks after diagnosis. Increases in incidence are attenuated among vaccinated individuals. Monitoring for gastrointestinal diseases after severe COVID-19 and promotion of vaccination in vulnerable groups are key to reducing long-term burden.", "abstract_shown": true, "affiliations": [ "Population Health Science, University of Bristol, Bristol, UK.", "British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.", "Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK.", "Translational Medical Sciences, University of Nottingham School of Medicine, Nottingham, UK.", "Gastrointestinal and Liver Theme, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), University of Nottingham, Nottingham, UK.", "Faculty of Health and Life Sciences, University of Exeter, Exeter, UK.", "Academic Unit of Ageing and Stroke Research, University of Leeds, Leeds, UK.", "Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.", "MRC Unit for Lifelong Health & Ageing, University College London, London, UK.", "NIHR Bristol Biomedical Research Centre, Bristol, UK.", "Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA." ], "article_type": "research article", "arxiv": null, "author_total": 20, "authors": [ { "affs": [ 0 ], "name": "Marwa Al Arab", "orcid": "0000-0001-7514-1551" }, { "affs": [ 1, 2 ], "name": "Genevieve Cezard" }, { "affs": [ 3, 4 ], "name": "Colin Crooks" }, { "affs": [ 5 ], "name": "Yinghui Wei", "orcid": "0000-0002-7873-0009" }, { "affs": [ 0 ], "name": "Elsie Horne" }, { "affs": [ 0 ], "name": "Tom M Palmer", "orcid": "0000-0003-4655-4511" }, { "affs": [ 6 ], "name": "Jose I Cuitun Coronado", "orcid": "0000-0001-6285-1394" }, { "affs": [ 7 ], "name": "Alex J Walker" }, { "affs": [ 7 ], "name": "Millie Green" }, { "affs": [ 7 ], "name": "Louis Fisher" }, { "affs": [ 7 ], "name": "Jon Massey" }, { "affs": [ 7 ], "name": "Simon Davy" }, { "affs": [ 7 ], "name": "Amir Mehrkar", "orcid": "0000-0002-2098-1278" }, { "affs": [ 7 ], "name": "Sebastian Bacon", "orcid": "0000-0002-6354-3454" }, { "affs": [ 7 ], "name": "Ben Goldacre" }, { "affs": [ 8 ], "name": "Nishi Chaturvedi" }, { "affs": [ 1, 2 ], "name": "Angela Wood", "orcid": "0000-0002-7937-304X" }, { "affs": [ 0, 9 ], "name": "Jonathan A C Sterne" }, { "affs": [ 10 ], "name": "Venexia Walker" }, { "affs": [ 0, 9 ], "name": "Rachel Denholm" } ], "bibtex": "https://research.draconitic.com/paper/drzvh8vrzvg5e.bib", "cited_by": 0, "doi": "10.1136/bmjph-2025-004709", "fulltext_url": "https://europepmc.org/articles/PMC13691888", "id": "drzvh8vrzvg5e", "issns": [ "2753-4294" ], "landing_url": "https://europepmc.org/article/MED/42921189", "language": "eng", "licence": "CC-BY", "licence_label": "CC BY", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2725|COVID-19 Clinical Research Studies" ] ], "openalex": "W7223051386", "pdf_url": "https://europepmc.org/articles/PMC13691888?pdf=render", "pmcid": "PMC13691888", "pmid": "42921189", "published": "2026-10-20", "publisher": null, "ris": "https://research.draconitic.com/paper/drzvh8vrzvg5e.ris", "sources": [ { "first_seen": "2026-10-30T12:20:33Z", "native_id": "MED:42921189", "source": "europepmc", "url": "https://europepmc.org/article/MED/42921189" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2725|COVID-19 Clinical Research Studies", "subfield": "infectious-disease" } ], "title": "Impact of COVID-19 on gastrointestinal disease in vaccinated and unvaccinated individuals: a population-based cohort study in England.", "title_text": "Impact of COVID-19 on gastrointestinal disease in vaccinated and unvaccinated individuals: a population-based cohort study in England.", "type": "peer-reviewed", "updated_at": "2026-10-30T12:20:33Z", "url": "https://research.draconitic.com/paper/drzvh8vrzvg5e", "venue": "BMJ public health", "versions": [] }