Since the novel COVID-19 virus was discovered late last year, the complexities of the virus have amazed scientists. Its capacity to rapidly spread among populations has challenged the most developed epidemiological centers globally. Likewise, its ability to quickly wreak havoc on the respiratory system has resulted in hundreds of thousands of deaths. The initial reaction was to assume COVID-19 was similar to other viral pandemics like influenza. But this has not turned out to be the case. In fact, COVID-19 continues to perplex researchers even as new discoveries are found.
Understanding this, some of the latest research findings are now highlighting how COVID-19 and GI symptoms are often linked. Gastrointestinal complaints are not only common, but they may be presenting symptoms in some populations. At the same time, COVID-19 and GI symptoms may have long-term effects on gastrointestinal health. Given the importance gut health is to immune function, this has notable implications. While much more needs to be learned about COVID-19 and gut health, it’s clear a distinct connection exists.
“We used to think of SARS-CoV-2 as just a pulmonary or respiratory disease. But over the last couple months, a lot of evidence has emerged that SARS-CoV-2 also affects the intestinal tract.” – Siew Chien Ng, Assistant Dean of Medicine, Chinese University in Hong Kong’s Centre for Gut Microbiota Research
COVID-19 and GI Symptoms Common
It’s now common knowledge that COVID-19 primarily presents with respiratory symptoms in symptomatic individuals. Cough, shortness of breath, sore throat, and loss of taste and smell are well-recognized as potential features. But it’s increasingly evident that COVID-19 and GI symptoms are also common. Overall, 80 percent of symptomatic patients describe having a loss of appetite. Likewise, a fifth of these patients have other GI symptoms like diarrhea, vomiting and abdominal pain. Based on this, researchers began to suspect the virus may also have a negative effect in gut health.
In exploring this matter further, researchers in China began collecting stool samples of individuals infected with the virus. They enrolled both symptomatic and asymptomatic patients in the study. The results interestingly showed that half of all the patients had positive virus titers in their stool. In fact, many have persistently positive stool tests a week or more after respiratory tests were no longer positive. This not only pertained to patients with COVID-119 and GI symptoms but to asymptomatic individuals as well. Based on this evidence, it’s clear that the virus is able to attack areas outside the lung.
“…We have learnt that half of children participating in this study are asymptomatic with SARS-CoV-2 infection, and those with symptoms do not typically have a cough or changes to their smell/taste, with gastrointestinal upset a far more common symptom.” – Tom Waterfield, MD, Medical Researcher, Wellcome-Wolfson Institute for Experimental Medicine at Queen’s University Belfast
COVID-19, Gut Health and Children
The research involving adult stool samples are not the only interesting finding regarding COVID-19 and gut health. Another recent research study examined roughly 1,000 children who were known to be infected with the virus. Half were asymptomatic whole the other half were not. Of those who were symptomatic, many again had cough, fever, shortness of breath and other typical complaints. But notably, a much higher number of children had COVID-19 and GI symptoms. Diarrhea, vomiting and abdominal pain were much more common in this group when compared to adults.
This study was conducted in the United Kingdom at Queen’s University in Belfast. Likewise, the participants were ages 2 to 15 years overall. In reviewing the study, researchers could not explain why children’s gut health might be more vulnerable to COVID-19. However, they suspect that different developmental and immune features may be at play. Regardless, studies in both adults and children show that COVID-19 and GI symptoms are not rare occurrences. Not only does this have implication in detecting those with the disease. It may also be important in terms of transmission and new healthcare therapies as well.
“Our emerging understanding of COVID-19 has found the disease to have multisystem involvement including the nervous, cardiac, vascular [excess clotting] and finally the digestive systems, among others.” Sherif Andrawes, MD, Director of Gastrointestinal Endoscopy, Staten Island University
More Than an Infection
The effects that COVID-19 appears to have on gut health extends beyond virus particles in the lining of the gastrointestinal tract. In case, researchers suspect the same antigen targets that exist in the lung may also be present in the gut. As a result, viral particles that survive the stomach’s acidic environment might then attack GI cells. This is supported by changes in the microbiome of patients with COVID-19. The same Chinese researchers described above also found infected patients had reduced numbers of protective microbes in the GI tract. As such, COVID-19 and GI symptoms would be more common. For others with better disease tolerance, this may not be the case.
Other researchers have also noted that COVID-19 patients are at higher risk for other gut health problems. Specifically, radiologists have seen changes in imaging studies that suggest COVID-19 can cause reduced circulation to GI tissues. COVID-19 is known to increase the risk of clots in patients, which has even led to strokes. Therefore, the radiologist researchers suspect the bowel ischemia may result from small clots in GI circulation as well. All of these findings point to the fact that COVID-19 is not isolated to the respiratory system alone. Researchers are realizing it is clearly a multi-organ and systemic disease.
Long-Term Effects on Gut Health Unknown
The findings involving COVID-19 and GI symptoms remain relatively early at this point in time. The mechanisms by which COVID-19 affects gut health must be further studied and elucidated. However, current studies support the fact that virus has a negative impact on gut health in the short-term. This is why a sizable percentage of patients do have GI symptoms with their disease. What remains unclear, however, is the long-term effects of COVID-19 on gut health. Because much still must be learned, it’s clear that prevention remains the best approach to the situation.
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