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Post-COVID Gastrointestinal Sequelae

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Post-COVID Gastrointestinal Sequelae

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This article discusses in detail the post-COVID complications involving the gastrointestinal system and their management.

Medically reviewed by

Dr. Jagdish Singh

Published At November 6, 2021
Reviewed AtMarch 28, 2023

Introduction

The post-COVID-19 complications in people infected and successfully recovered from COVID-19 pose a new challenge to the people and the healthcare community. This article enumerates the post-COVID-19 gastrointestinal complications and explains in detail why they occur, who is prone to them, and their management methods.

What Does Post-COVID Complication Mean?

In the initial phases of COVID-19, during its advent, several people got infected and died. But some people who were infected, treated, and successfully recovered are now facing discomforts and ailments pertaining to several systems of the body such as the nervous, gastrointestinal, cardiovascular, urinary, and respiratory systems for prolonged periods ranging from months to a year after their recovery. These complications are termed post-COVID-19 complications or sequelae. They are also known as long COVID-19.

This has made the affected people’s lives stressful and drained. Their quality of life post-COVID-19 has been compromised. The number of people experiencing long COVID-19 is increasing day by day. Only a few people had post-COVID-19 complications in the initial wave, while a lot of people affected in the second wave are still experiencing the after-effects of COVID-19.

What Is Causing Post-COVID Gastrointestinal Complications?

Experts quote dysbiosis to be the cause of acute post-COVID-19 complications of the gastrointestinal tract. When a person gets exposed to SARS-CoV-2 initially, the host immune response gets triggered to fight against the viral infection. The angiotensin-converting enzyme 2 (ACE-2) receptors are situated in several organs of the body, including the epithelium of the gastrointestinal tract. The coronavirus gains entry into the cells of the gastrointestinal tract through the ACE-2 receptor and replicates in the gastrointestinal system. The presence of coronavirus in the feces and colonic tissues of the people who tested positive for COVID-19 is supporting evidence.

The gut microflora is affected, and there an imbalance occurs in the gut microbiome due to an increased inflammatory response. All the inflammatory mediators are upregulated to form cytokine storms. Dysbiosis is also linked to the effects of the coronavirus on the enteric nerves and a consequential immune response.

Apart from the coronavirus and the body’s inflammatory response, the drugs given during COVID-19 are also known to cause gastrointestinal complications as their side effects. The treatment regimen for COVID-19 includes many medicines in the form of oral tablets and intravenous injections. Oral antibiotics for a prolonged period impact intestinal flora, which could also cause GI complications. Also, in people with existing gastrointestinal diseases, their symptoms were worsened or exacerbated by COVID-19.

Yes. The changes in the gastrointestinal flora and functions due to COVID-19 impact the respiratory tract and vice versa. This is due to the common mucosal immune system. Though the fecal samples of COVID-affected people with gastrointestinal symptoms usually contain SARS-CoV-2, in some people, it was absent. So experts speculate that in such people, the gastrointestinal symptoms could not be due to the direct damage of the GI tract by the virus, but a respiratory tract infection could have affected the GI tract.

What Gastrointestinal Complications Can Occur Post COVID-19?

The coronavirus usually targets the respiratory system, but it is unusual for it to attack the gastrointestinal system. Though it is unusual, it is not uncommon. The following gastrointestinal symptoms are experienced by a large number of people testing positive for COVID-19. These complications can either occur during the viral phase, that is, during the infectious period right after a person contracts the infection and until the recovery, or after total recovery as long-term adverse gastrointestinal effects.

  • Nausea.

  • Vomiting.

  • Diarrhea.

  • Abdominal pain.

  • Appetite loss.

  • Anorexia.

  • Acid reflux.

  • Gastrointestinal bleeding.

  • Constipation.

  • Dyspepsia or indigestion.

Apart from the gut-related and intestinal issues, COVID-19 survivors have also reported pancreatic and liver manifestations.

  • Hypoglycemia - Due to an autoimmune response, there is an increased level of insulin secretion that causes low blood sugar levels characterized by shaking hands, sweating, excessive hunger, fainting, palpitations, etc.

  • Swelling of the Liver - Due to an inflammatory state of the body in COVID-19, the liver enzymes such as alanine aminotransferase and aspartate aminotransferasewere observed to increase along with swelling of liver cells. The infection, inflammation, and drugs to manage COVID-19 are to be blamed. COVID-affected people with gastrointestinal symptoms are at an elevated risk of liver damage.

Who Is at Risk of Developing Gastrointestinal Complications Post-COVID?

The following people are at an increased risk of post-acute COVID-19 gastrointestinal complications.

  • People who had severe COVID-19.

  • People who got admitted to the ICU (intensive care unit) for COVID treatment.

  • Elderly COVID-19 survivors.

  • Those who used extensive medications, including antibiotics and antivirals, for COVID-19 treatment.

It was also found that people with gastrointestinal symptoms were more prone to fatigue, headache, and cough than those without gastrointestinal symptoms due to COVID-19.

What Tests Help in the Diagnosis of Each GI Complication?

The diagnosis is chiefly through the presenting complaint and present symptoms.

Other than that, several other tests are also suggested to detect conditions such as pancreatitis and liver damage.

  • Liver function test.

  • Complete blood count.

  • CECT (contrast-enhanced computed tomography).

  • Helicobacter pylori stool and breath test.

  • UGIE (upper gastrointestinal endoscopy).

How Can Post-COVID Gastrointestinal Manifestations Be Managed?

  1. Take adequate rest.

  2. Drink plenty of fluids up to 3 liters a day.

  3. Take vitamin C, D, and calcium supplements with the physician’s advice.

  4. Take probiotics. Foods such as yogurt, kefir, buttermilk, kimchi, miso, etc., are the best probiotic foods.

  5. Avoid fried and heavy foods.

  6. Have a diet rich in fiber. Include more fruits and vegetables.

  7. Eat well-cooked food.

  8. If the gastrointestinal complication is suspected to be due to the side effect of drugs, the alleged drug should be discontinued, and alternative medicine will be prescribed by the treating physician.

  9. Oral rehydration solutions also need to be taken to replace the lost electrolytes in case of diarrhea and vomiting.

  10. In case of abdominal pain due to drug-induced ulceration of the stomach, antacids, and proton pump inhibitors will be prescribed.

Conclusion

Long COVID has indeed affected the quality of life of COVID survivors. The complications and discomforts should not be taken for granted. The healthcare workers have the responsibility to give importance and formulate treatment strategies for post-COVID complications similar to that of acute COVID symptoms and reassure every long hauler about their condition. If a person is a long hauler, experiencing any discomfort post-COVID, consult a physician and do not self-medicate.

Frequently Asked Questions

1.

How Long Do Gastrointestinal Issues Last After COVID?

Respiratory symptoms of COVID (Coronavirus disease) are widespread. But other than these, symptoms like skin problems, gastrointestinal disorders, and neurological problems may also be seen. Gastrointestinal symptoms of COVID are rare. In general, these symptoms last for four to five days. But in rare cases, these symptoms may last up to fourteen days.

2.

Can Long COVID Cause Gastrointestinal Disorder?

Long-term effects of COVID (Coronavirus disease) infection which persist even after the cure from COVID-19 infections, are known as long COVID. Post-COVID complications may include gastrointestinal symptoms also. Gastrointestinal symptoms include loss of appetite, nausea, vomiting, chronic acidity, and abdominal pain.

3.

Does COVID Affect the Digestive System?

Yes, COVID may affect digestive symptoms. During COVID (Coronavirus disease) infection, patients may complain of symptoms like nausea, vomiting, constipation, indignation, abdominal pain, and chronic acidity. Such symptoms may persist even after curing COVID-19 infection.

4.

What Are the Different Complications After Recovering From COVID-19?

After curing COVID-19 infection, patients may complain of different complications. Such complications are called long COVID, which include skin problems, neurological problems, digestive disorders, and cardiovascular issues.

5.

Can COVID Cause IBS Flare-Up?

Yes, COVID may cause IBS (irritable bowel syndrome) flare-ups. This flare-up may be caused by gastrointestinal complications, changes in microflora, and psychological stress. Even COVID-19 infection may cause IBS-like symptoms.

6.

Which Organs Are Affected by Long Term Effect of COVID?

Different organs can be affected by long-term COVID complications. Patients may complain of a burning sensation in the skin due to neurological disorders. Skin rashes are caused by skin involvement due to changes in the immunity system. Patients may complain of migraine-like pain or brain for due to the involvement of the nerves. Cardiovascular problems and gastrointestinal problems also may persist.

7.

How to Treat Post-covid Symptoms?

Treatment of post-COVId complications is difficult. Psychological management and asking the patient to live a healthy lifestyle are necessary for reducing complications. Symptomatic management is also necessary.

8.

Does COVID Affect Bowel Movements?

Yes, COVID may affect bowel movements. During COVID infection, patients may complain of diarrhea, constipation, nausea, vomiting, and indignation. These symptoms may persist after curing COVID infections.

9.

How To Treat Post-infectious IBS?

Changes in the gut microflora cause post-infectious IBS (irritable bowel syndrome). For the treatment of such complications, antibiotics and probiotics are prescribed. Patients are also advised to take low-fermentation diets during this period.

10.

What Is the Treatment of COVID Diarrhea?

COVID diarrhea is caused by changes in the gut movement and alteration in the gut microflora. For the treatment of COVID diarrhea, probiotics, and antimotility drugs are prescribed.

11.

What Is the Cause of COVID Diarrhea?

COVID diarrhea is caused by multiple factors. Due to the COVID infection, the cellular mechanism of the gut is altered. This causes altered inflammatory response and abnormal gut motility. Also, the alteration of gut microflora is associated with this.

12.

Can One Have Diarrhea With Long COVID?

Yes, diarrhea can be a symptom of long COVID. COVID causes changes in the gut environment and inflammatory response. This causes diarrhea-like symptoms in long COVID.

13.

Is Diarrhea a Symptom of COVID Reinfection?

Diarrhea can be caused by several factors. Indignation and gut infection are the most common causes of diarrhea. In COVID also, diarrhea-like symptoms can be seen due to the change in the gut microflora. Thus, diarrhea is not only related to COVID but can be linked to other disorders also.
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Dr. Jagdish Singh
Dr. Jagdish Singh

Medical Gastroenterology

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