The new coronavirus (SARS-CoV-2) is currently spreading around the world and affects us in many different ways. We read about all the tragic deaths and seriously ill people daily, but fortunately, most of those affected by the virus recover. Typical symptoms of the virus are dry cough, fever and shortness of breath, but it has also been shown that gastrointestinal problems often occur with COVID-19.
Common gastrointestinal problems associated with COVID-19
A review of 20,133 patients treated in UK hospitals was recently published in The British Medical Journal (1). This article reported that various symptoms from the gastrointestinal tract such as abdominal pain, diarrhea and vomiting are common in COVID-19.
Diarrhea affected 20.4% (22.0% of women and 19.3% of men) and nausea / vomiting affected 19.8% (23.5% of women and 17.3% of men)..
This puts these symptoms in the top ten (ranked 8 and 9) among the most common symptoms of COVID-19, at least in those who were cared for in hospitals in the UK. Abdominal pain was ranked 13th among the most common symptoms and affected 10.2% (11.4% of women and 9.3% of men).
Sometimes gastrointestinal problems are the only symptoms
The list of different symptoms is long and it is not the case that the same patient shows all symptoms at the same time. The vast majority (approximately 70%) still had one or more of the common symptoms: fever, cough and/or shortness of breath.
Earlier this year, in another significantly smaller study with 74 patients from China, it was found that 21patients (28.38%) only showed symptoms from the gastrointestinal tract in the form of nausea, vomiting and/or diarrhea (2). These patients did not have the usual symptoms such as cough but still had COVID-19 (SARS-Cov-2 infection). It can be difficult to compare different studies from different countries and different situations, but in any case it seems as if you can actually have the viral disease and only get certain symptoms from the gastrointestinal tract.
The virus remains in the stool for a long time
But several studies have also shown that even in those who have no problems in the gastrointestinal tract, the virus is still often found in the stool. It has even been possible to use samples from the sewage to assess how the infection develops.
Endoscopy has shown that the virus seems to be able to exist in different places in the gastrointestinal tract, such as the esophagus, stomach, duodenum and rectum. It also appears that the virus may remain in the gastrointestinal tract for some time even though the virus has left the airways. In one study, half of the patients had the virus in their stool 11 days after airway samples were negative for the virus (4).
The virus enters the cells
It is known that the virus enters the cells via a receptor (receptor on the cells) called ACE2. This receptor is found in the intestines and is involved in regulating inflammation. It also seems that cells in the gastrointestinal tract have other properties that allow the virus to enter them. Among other things, cells in the gastrointestinal tract, just like cells in the lungs, produce certain enzymes that the virus needs to attack the cells.
COVID-19 and IBD
The link between the virus and inflammation in the intestines has raised the question of whether people with inflammatory bowel disease (IBD Crohn’s and Ulcerative Colitis) could be more exposed to the virus than others due to an altered expression of the ACE2 receptor in the intestines due to inflammation. However, more research is needed on this in order to be able to confirm such a connection. It is not known today why gastrointestinal problems with COVID-19 are so common or if the gastrointestinal tract could be an alternative route for the virus to enter the body. One question that puzzles us, for example, is how the virus manages to get past the extreme pH to which it is exposed in the gastrointestinal tract. We at alltomibs.com of course follow the development of this virus and its effects on the gastrointestinal tract.
Read more about gastrointestinal symptoms and COVID-19 at theromefoundation.org
1 Docherty AB, Harrison EM, Green CA, et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ. 2020;369:m1985. Published 2020 May 22. doi:10.1136/bmj.m1985 LÄNK
2 Jin X, Lian JS, Hu JH, et al. Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut. 2020;69(6):1002‐1009. doi:10.1136/gutjnl-2020-320926 LÄNK
3 Ng SC, Tilg H. COVID-19 and the gastrointestinal tract: more than meets the eye. Gut. 2020;69(6):973‐974. doi:10.1136/gutjnl-2020-321195 LÄNK
4 Wu Y, Guo C, Tang L, et al. Prolonged presence of SARS-CoV-2 viral RNA in faecal samples. Lancet Gastroenterol Hepatol. 2020;5(5):434‐435. doi:10.1016/S2468-1253(20)30083-2 LÄNK