Gastrointestinal complications of COVID-19

By Dr Rajiv Lochan,

The novel COVID-19 infection was predominantly thought to attack the respiratory system with the common manifestation of high-grade fever, sore throat, cough, breathlessness, pneumonia, etc. However, with more evidence now being available, it is clear that the virus can attack several other organs of the body, including the gastrointestinal tract.

“One in every five positive patients show at least one gastrointestinal symptom, most commonly diarrhoea, stomach pain, nausea and vomiting. Severe patients needing hospitalization and children most commonly display these symptoms. A recent study showed that about 53% of the COVID-19 patients requiring hospitalization have concomitant gastrointestinal issues” said Dr Rajiv Lochan, Lead Consultant – Liver Transplantation & Hepato-Pancreato-Biliary Surgery, Manipal Hospitals, Old Airport Road. “Emerging evidence also shows that nearly 20% of the positive cases may only have gastrointestinal symptoms, without fever or any respiratory symptoms. Such patients may not consider COVID-19 testing or seek medical help immediately. This can cause rapid spread of the infection to others unknowingly” further elaborated Dr Rajiv.

Around 10% of patients who develop COVID infection can develop GI manifestations of COVID-19. Some of these patients might not have any respiratory symptoms at all.

The most common symptoms of active infection may include food poisoning like symptoms lasting between 1-14 days – nausea, abdominal pain, vomiting and or diarrhoea. These patients are more likely to be ill for a longer period as compared to those with only respiratory symptoms.

The most common post-recovery symptoms may include loss of appetite, abdominal pain and discomfort, bloating, nausea and vomiting and acid reflux. It is important to understand that in patients with gastrointestinal symptoms, the live virus can be detected in the stool even after the respiratory symptoms have subsided. This can infect other people in contact.

The virus can also cause GI bleeding, rise in liver enzymes, inflammation of the GI tract, liver and pancreas. This risk is especially high in patients with pre-existing gastrointestinal conditions such as liver transplantation, cirrhosis, inflammatory bowel disease, Crohn’s disease, etc. Evidence suggests that the risk of death in these patients is about 4-5 times higher when infected with COVID-19 as compared to other infected patients.

Very rarely, the COVID-19 infection can also cause fungal infection of the small intestine, characterized by severe abdominal pain and associated with increased risk of severe infection and death.

This viral infection can cause an increased risk of blood clots in the blood vessels of the Gastro intestinal tract too. Indeed we have seen such complications in our patients and is a particular cause of concern.

Mechanism of GI involvement

Evidence gathered so far suggests that the COVID-19 virus can impact the digestive tract in many ways. Firstly, the virus primarily binds to angiotensin-converting enzyme 2 (ACE 2) receptors in the human body present in the oral cavity, respiratory tract, digestive tract, kidney, spleen, liver, and brain. These receptors are highly prevalent in the gastrointestinal tract, about 100-folds higher as compared to the respiratory tract, allowing the virus to infect and rapidly multiply in the digestive tract. This can disrupt the normal gut microflora causing indigestion, diarrhoea, bloating, etc. The virus can also interfere with the proper functioning of the GI tract, liver, pancreas, etc by directly damaging GI cells, promoting inflammation through the release of cytokines, or blocking blood vessels supplying the GI tract through clot formation

Prevention and Management

Given the scenario of the ongoing pandemic, it is best to not let our guards down in the fight against this deadly virus. Patients experiencing gastrointestinal symptoms are thereby recommended to use a separate washroom altogether to avoid spread to others. It is also important to maintain hand hygiene and disinfecting the washroom after every use.

Management is symptomatic and differs from patient to patient. However, keeping a few things in mind can help your symptoms to go away soon

• Eat small meals throughout the day
• Avoid oily, spicy, and processed food. Cut down on sugars. These can slow down digestion and add to your GI discomfort
• Choose healthy home-cooked food over outside food to avoid the risk of GI infections
• Include fresh fruits and vegetables, whole grains in your diet to provide your body with essential nutrients for recovery
• Go easy on dairy products and red meat which can be hard for on your GI tract
• Keep yourself adequately hydrated, especially if you are vomiting or having diarrhoea. Restrict your intake of tea, coffee and fruit juice. Choose tender coconut water or buttermilk instead
• Exercise such as brisk walking or jogging to improve digestion
• Seek medical help in case of blood in stool, severe abdominal pain, nausea and vomiting
• Avoid smoking and alcohol. These promote hyperacidity.

Conclusion

Gastrointestinal symptoms are common in COVID-19 infection and last for about 14 days or longer. Though most of these symptoms are self-resolving, it has the potential to spread to others unless proper hygiene is maintained. Patients with existing gastrointestinal conditions should be cautious in case of diarrhoea, vomiting, stomach pain, etc and seek immediate medical help to avoid complications.

(The author is Lead Consultant – Liver Transplantation & Hepato-Pancreato-Biliary Surgery, Manipal Hospitals, Old Airport Road, Bengaluru. The article is for informational purposes only. Please consult medical experts and health professionals before starting any therapy, medication and/or remedy. Views expressed are personal and do not reflect the official position or policy of the Financial Express Online.)