Impact of COVID-19 on gastrointestinal disease in vaccinated and unvaccinated individuals: a population-based cohort study in England 🚨COVID leaves a years-long GI scar, even after mild cases, far worse after hospitalisation. Vaccination cuts the damage sharply. New OpenSAFELY data on 18M+ people👇 ➡️This interesting OpenSAFELY population-based cohort study (linked NHS data on ~18–24 million English adults) examined incidence of 10 gastrointestinal diseases (upper/lower GI bleeding, pancreatitis, appendicitis, GERD, dyspepsia, peptic ulcer, NASH, gallstones, IBS) after COVID-19 diagnosis versus before/without it. ➡️The study analysed three separate cohorts to compare gastrointestinal disease risk after COVID-19 according to vaccination era and status: 1. Pre-vaccination cohort (January 2020 – June 2021; n ≈ 18.4 million): - This period captured the highest elevations, - After hospitalised COVID-19, the adjusted hazard ratio (aHR) for upper gastrointestinal bleeding was 20.1 in weeks 1–4 and remained elevated at 1.90 in weeks 53–102, - After non-hospitalised COVID-19 the corresponding aHRs were 1.92 and 1.34, - Similar patterns were seen across the other nine gastrointestinal outcomes, - Excess risk of upper GI bleeding at 28 weeks was approximately 159 per 100,000 people diagnosed with COVID-19, - Elevated incidence persisted for up to two years, driven mainly by severe/hospitalised cases. - Period when the Wuhan/Alpha variant was dominant. 2. Vaccinated cohort (June – December 2021; n ≈ 14.9 million): - aHRs were consistently lower than in the other two cohorts, - For upper GI bleeding in weeks 1–4 the overall aHR was 1.84; after hospitalised COVID-19 it was 15.2 and after non-hospitalised disease it was 1.20, - Excess risk of upper GI bleeding at 28 weeks fell to about 60 per 100,000, - Vaccination attenuated both the early peak and the longer-term elevation, - Period when the Delta variant was dominant (until Omicron became dominant near the end of follow-up). 3. Unvaccinated cohort (June – December 2021; n ≈ 3.5 million) - Risks were higher than in the vaccinated group and closer to the pre-vaccination era, - For upper GI bleeding in weeks 1–4 the overall aHR was 4.26, after hospitalised COVID-19 it was 19.7 and after non-hospitalised disease it was 2.14, - Excess risk of upper GI bleeding at 28 weeks was approximately 112 per 100,000, intermediate between the pre-vaccination and vaccinated cohorts, - Period when the Delta variant was dominant (until Omicron became dominant near the end of follow-up). ➡️Across all three cohorts the elevation was greatest after hospitalised COVID-19, increased with age, and was attenuated by prior vaccination. ➡️The longest persistence (up to two years) was observed in the pre-vaccination cohort. ‼️So, severe COVID-19 leaves a years-long elevated risk of gastrointestinal disease that vaccination meaningfully blunts but does not erase. ‼️Again, the vaccinated were the smartest! Data above support AGAIN vaccination as an important public health intervention in reducing severe COVID-19 outcomes and its possible consequences! ‼️At population scale this translates into substantial extra GI bleeding, reflux, pancreatitis and related diagnoses for years after infection, concentrated among older people and those hospitalised. It increases outpatient, endoscopic and hospital burden, especially in high-prevalence periods, and underscores why preventing severe COVID-19 remains clinically relevant long after the acute phase. #Mitigation #AvoidSars2 #AvoidReinfections #UpdateVaccination bmjpublichealth.bmj.com/cont…