Long COVID and the Gastrointestinal System: Emerging Evidence

Slideshow below.

Long COVID is defined by WHO as the development or continuation of new symptoms 3 months after COVID-19 infection, with symptoms lasting for at least 2 months that have no alternative explanation.^1,2

Long COVID often includes neuropsychiatric and GI symptoms.^1,2 GI manifestations are well known during acute COVID-19, but less understood in long COVID.² It is estimated that 12% of patients with long COVID have GI symptoms, which may include heartburn, constipation, abdominal pain, nausea and vomiting, and diarrhea.^2,3 Patients with long COVID also frequently receive new GI diagnoses, such as functional dyspepsia, IBS, GERD, peptic ulcer disease, and acute pancreatitis.^2,3

Proposed causes of GI symptoms post-COVID are varied, including alterations in the gut microbiome and serotonergic signaling and changes downstream from the angiotensin-converting enzyme 2 receptor.^2,4 The serotonergic theory links the pathophysiology of long COVID GI symptoms to post-infection IBS and other disorders of gut-brain interaction. Like IBS, long COVID with GI symptoms is frequently associated with non-GI comorbidities, especially mental health comorbidities.⁵

Currently, no specific treatments are endorsed for long COVID GI symptoms.⁴ Management focuses on symptom relief and using protocols for the relevant GI disorders; when IBS is present, an integrated and multidisciplinary approach is recommended.^4,6 This multifaceted approach, when possible, can be especially helpful in patients with long COVID because of the number of comorbidities and varied symptoms.^1,4-6 Long COVID and its multitude of symptoms have a profound negative effect on productivity and quality of life in patients.^1,7 Thus, finding efficient treatment approaches is a top priority in navigating the complexity of long COVID and its GI manifestations.

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