Impact of COVID-19 on gastrointestinal disease in vaccinated and unvaccinated individuals: a population-based cohort study in England.
11 affiliations
- 1Population Health Science, University of Bristol, Bristol, UK.
- 2British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
- 3Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK.
- 4Translational Medical Sciences, University of Nottingham School of Medicine, Nottingham, UK.
- 5Gastrointestinal and Liver Theme, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), University of Nottingham, Nottingham, UK.
- 6Faculty of Health and Life Sciences, University of Exeter, Exeter, UK.
- 7Academic Unit of Ageing and Stroke Research, University of Leeds, Leeds, UK.
- 8Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
- 9MRC Unit for Lifelong Health & Ageing, University College London, London, UK.
- 10NIHR Bristol Biomedical Research Centre, Bristol, UK.
- 11Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Abstract
Background
COVID-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
To investigate the relationship between COVID-19 and gastrointestinal diseases by vaccination status in hospitalised and non-hospitalised patients.Design
With 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
COVID-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
The 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.
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BibTeX
@article{arab2026impact,
title = {{Impact of COVID-19 on gastrointestinal disease in vaccinated and unvaccinated individuals: a population-based cohort study in England.}},
author = {Marwa Al Arab and Genevieve Cezard and Colin Crooks and Yinghui Wei and Elsie Horne and Tom M Palmer and Jose I Cuitun Coronado and Alex J Walker and Millie Green and Louis Fisher and Jon Massey and Simon Davy and Amir Mehrkar and Sebastian Bacon and Ben Goldacre and Nishi Chaturvedi and Angela Wood and Jonathan A C Sterne and Venexia Walker and Rachel Denholm},
journal = {BMJ public health},
year = {2026},
month = oct,
doi = {10.1136/bmjph-2025-004709},
url = {https://europepmc.org/article/MED/42921189},
note = {CC BY},
}
RIS
TY - JOUR
TI - Impact of COVID-19 on gastrointestinal disease in vaccinated and unvaccinated individuals: a population-based cohort study in England.
AU - Marwa Al Arab
AU - Genevieve Cezard
AU - Colin Crooks
AU - Yinghui Wei
AU - Elsie Horne
AU - Tom M Palmer
AU - Jose I Cuitun Coronado
AU - Alex J Walker
AU - Millie Green
AU - Louis Fisher
AU - Jon Massey
AU - Simon Davy
AU - Amir Mehrkar
AU - Sebastian Bacon
AU - Ben Goldacre
AU - Nishi Chaturvedi
AU - Angela Wood
AU - Jonathan A C Sterne
AU - Venexia Walker
AU - Rachel Denholm
PY - 2026
DA - 2026/10/20
JO - BMJ public health
DO - 10.1136/bmjph-2025-004709
UR - https://europepmc.org/article/MED/42921189
AB - Background COVID-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 To investigate the relationship between COVID-19 and gastrointestinal diseases by vaccination status in hospitalised and non-hospitalised patients.Design With 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 COVID-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 The 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.
SN - 2753-4294
ER -