The gastrointestinal disease is another facet of the multifaceted Long Covid


WHO defines long COVID as post-COVID-19 condition that occurs in individuals with a history of probable or confirmed SARS-CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis.

In a subset of convalescent individuals, long-term sequelae termed ‘long COVID’, or ‘post-acute COVID-19 syndrome’ (PACS) are increasingly reported, with the most common manifestations being systemic, neuropsychiatric, cardio-respiratory and gastrointestinal 1.

Owing to the robust constitutive expression of angiotensin-converting enzyme 2 on the brush border of the small intestinal mucosa, acute COVID-19 is associated with gastrointestinal symptoms such as nausea, vomiting, diarrhoea and abdominal pain 1.

In patients with PACS, gastrointestinal-related symptomatology includes loss of appetite, nausea, weight loss, abdominal pain, heartburn, dysphagia, altered bowel motility and irritable bowel syndrome1.

Emerging evidence demonstrates persistent and aberrant inflammation as well as induction of autoimmunity in a subset of patients with PACS1 (Fig. 1). Viral persistence beyond acute COVID-19 has also been documented within multiple organs, including the gastrointestinal tract and central nervous system1. However, conclusive evidence linking viral persistence to PACS has not been demonstrated thus far.

Fig. 1
The pathophysiology of PACS and gastrointestinal PACS.
The external blue circle represents proposed pathophysiological mechanisms in post-acute COVID-19 syndrome (PACS). The internal grey circle represents gastrointestinal-PACS-specific pathophysiological mechanisms. ITP, idiopathic thrombocytopenic purpura.

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A new study by researchers from VA Saint Louis Health Care System, Saint Louis -USA and Washington University School of Medicine, Saint Louis-USA led by Dr Ziyad Al-Aly has found that most that people with SARS-CoV-2 infection are at increased risk of gastrointestinal disorders in the post-acute phase of COVID-19.

The study findings were published in the peer reviewed journal: Nature Communications.

A comprehensive evaluation of the risks and 1-year burdens of gastrointestinal disorders in the post-acute phase of COVID-19 is needed but is not yet available.

Here the researches use the US Department of Veterans Affairs national health care databases to build a cohort of 154,068 people with COVID-19, 5,638,795 contemporary controls, and 5,859,621 historical controls to estimate the risks and 1-year burdens of a set of pre-specified incident gastrointestinal outcomes.

The researchers show that beyond the first 30 days of infection, people with COVID-19 exhibited increased risks and 1-year burdens of incident gastrointestinal disorders spanning several disease categories including motility disorders, acid related disorders (dyspepsia, gastroesophageal reflux disease, peptic ulcer disease), functional intestinal disorders, acute pancreatitis, hepatic and biliary disease.

The risks were evident in people who were not hospitalized during the acute phase of COVID-19 and increased in a graded fashion across the severity spectrum of the acute phase of COVID-19 (non-hospitalized, hospitalized, and admitted to intensive care). The risks were consistent in comparisons including the COVID-19 vs the contemporary control group and COVID-19 vs the historical control group as the referent category.

Altogether, our results show that people with SARS-CoV-2 infection are at increased risk of gastrointestinal disorders in the post-acute phase of COVID-19. Post-covid care should involve attention to gastrointestinal health and disease.


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