Everyone is eager to manage COVID the way we manage the flu — that is, receiving a once-a-year shot that mitigates the risk of serious illness. Unfortunately, COVID is different. About one in every five American adults who contracts the virus develops Long COVID, or long-term health problems linked to the initial illness that can last weeks, months, or years. And unfortunately, we are still far from understanding everything about Long COVID and how it works.
Indeed, the CDC lists only two digestive symptoms for Long COVID — diarrhea and stomach pain — though a recent study suggests that many more gastrointestinal symptoms exist. Below, we take a look at the research and why a COVID infection could cause long-term gut issues.
A study published in the journal Nature explored the gastrointestinal (GI) symptoms that some people experience after contracting COVID. During the investigation, researchers collected healthcare data on over 154,000 Americans who were diagnosed with COVID between 2020 and 2022. They compared this group to 5.6 million people who had zero evidence of a COVID infection in the same time period. Lastly, they looked at data from 5.8 million people who submitted their health records prior to the pandemic. (Looking at pre-pandemic health records helped the researchers determine the instances of gut issues prior to COVID.)
Here’s what the researchers learned: People who contracted COVID and survived the first 30 days of the illness were more likely to develop gastroesophageal reflux (think acid reflux, indigestion, and heartburn) than people in the non-COVID groups. They were also more likely to develop:
- Peptic ulcer disease: Open sores or raw areas in the lining of the stomach/intestine.
- Acute pancreatitis: Inflammation of the pancreas — when digestive enzymes start digesting the pancreas itself. Acute pancreatitis goes away a few days after treatment.
- Functional dyspepsia: A pain or uncomfortable feeling in the upper middle area of the stomach.
- Acute gastritis: The sudden inflammation of the stomach lining, characterized by loss of appetite, upper abdominal discomfort, burping, and nausea. Prolonged gastritis can lead to ulcers.
- Irritable bowel syndrome: Abdominal pain and cramping, changes in bowel habits, bloating, gas.
- Cholangitis: Inflammation of the bile duct system, which carries bile from your liver and gallbladder into the entrance of your small intestine. It’s characterized by pain in your abdomen, fever, chills, jaundice, nausea, clay-colored stool, and lethargy.
In addition, these GI symptoms appeared in post-COVID patients regardless of age, gender, or severity of the initial infection.
COVID, Gluten Intolerance, and Celiac
Many people who contracted COVID are also now experiencing gluten intolerance and Celiac disease — and they’re wondering if the virus had something to do it.
Some scientists hypothesized in 2021 that COVID damages the intestinal barrier, which then allows gliadin (a type of protein in gluten) to seep into the gut lining and cause further damage. This could cause an autoimmune reaction in the gut, which may trigger gluten intolerance or, in some cases, Celiac disease (if the patient has a genetic pre-disposition). However, there isn’t enough direct evidence yet to prove that COVID causes Celiac.
Why COVID May Cause Gut Problems
As Bloomberg Prognosis points out, COVID likes to “hide” in areas of the body where immune defenses aren’t as strong. In fact, one virologist recently discovered that COVID can hide and sometimes mutate in the gut. Stool samples from one person proved that the virus was alive and well more than a year after an initial infection, and had evolved to outsmart the person’s immune system.
Researchers also believe that the virus can hide in human cells, fat, and tissues, not unlike HIV and shingles. In effect, while the virus predominantly affects the respiratory system, a chronic infection could last in the gut as well.
What This Means for You
There isn’t yet a solution for the long-lasting gut problems that a COVID infection may cause, but knowledge is power. If you think you have chronic GI issues because of COVID, talk to a gastroenterologist about your symptoms. It’s important to rule out other causes first. In addition, you may need to talk to more than one doctor, as not every recommendation will work for you. (For instance, certain heartburn medications like proton pump inhibitors (PPIs) will treat GERD symptoms, but PPIs may negatively alter the gut microbiome, which could dampen the gut’s immune defenses.)
Some doctors recommend that you stay hydrated and eat a Mediterranean diet. You may also consider trying an elimination diet for about five weeks to determine which foods trigger your symptoms. (On an elimination diet, you limit your diet to a small selection of whole foods, and add in new whole foods one by one, monitoring your symptoms.) Above all, stay up to date on your research. As new information becomes available, you may learn something that helps you.
This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.
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