The devastating second wave of COVID-19 in India is now finally showing signs of abating. From an all-time high of 4 lakh+ cases per day in early May, the country is now recording a relatively modest figure of 1 lakh new cases every day. However, the declining second wave of COVID-19 has coincided with an increase in the number of patients, including children, reporting digestive or gastrointestinal (GI) problems. The article below explores the gastrointestinal manifestation of COVID-19 in detail.

Digestive and gastrointestinal problems associated with COVID-19

The most common digestive problems associated with COVID-19 are lack of appetite, nausea or vomiting, diarrhoea, and abdominal pain. People who are recovering from COVID-19 may also experience other problems such as constipation, bloating, acid reflux, colitis (intestinal inflammation), gastrointestinal bleeding, and worsening of irritable bowel disease (IBD).

How does COVID-19 affect the digestive system?

Scientists all over the world are trying to learn more about the mechanism through which the SARS-CoV-2 virus affects different organs in the human body. Multiple studies indicate that the virus enters the intestinal cells (enterocytes) using the angiotensin-converting enzyme 2 (ACE-2) protein as a receptor. Using the spike-like protein on its surface, the virus enters the intestinal cells by binding to their ACE2 receptors. This is the same mechanism through which the virus enters the cells in the respiratory cells.

Once inside the intestinal cells, the virus utilizes the cells’ biological machinery to manufacture copies of the viral proteins and genetic material (ribonucleic acid or RNA).  When an intestinal cell is infected by the SARS-CoV-2 virus, it stimulates the release of cytokines (tiny proteins involved in inflammation). Scientists say that this process may be responsible for the gastrointestinal (GI) symptoms of the COVID-19.

However, there can be other possible causes of the GI symptoms as well. For instance, GI symptoms can also occur as the SARS-CoV-2 virus damages the gastrointestinal tissues. The impact of the virus on the vagus nerve is believed to be responsible for the symptoms such as nausea and vomiting. The use of antibiotics and antivirals to manage COVID-19 in children and adults can also trigger symptoms like nausea and diarrhoea.

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Are children at a greater risk of experiencing digestive problems due to COVID-19?

Compared to adults, children with COVID-19 are less likely to experience severe illness. The reduced risk can be attributed to the lower expression of ACE2 receptors in children which the SARS-CoV-2 virus uses to enter and infect the cells. Nevertheless, like adults, digestive problems are frequently observed in children with COVID-19. In fact, in many cases, digestive problems are the sole manifestation of the disease in children. According to a report, children with COVID-19 who develop GI symptoms are at a greater risk of experiencing severe, critical infections and cardiac impairments.

Should people with pre-existing digestive disorders take extra precautions?

Although people with certain gastrointestinal problems like inflammatory bowel disease (IBD) are at a greater risk of contracting some types of viral infections, there is no available scientific evidence to indicate that people with IBD are more likely to develop COVID-19 than others.

Nevertheless, people with pre-existing gastrointestinal problems like IBD should take extra precautions to avoid the SARS-CoV-2 virus. As some of the medications for IBD suppress the immune system, such people should also consult their physician if they should stop taking certain medications.

Recommended Read: 5 Most Common Digestive Disorders Explained

Reducing the risk of digestive problems associated with COVID-19

Digestive problems such as abdominal pain, nausea, and diarrhoea can have many causes other than COVID-19. The onset of these symptoms does not automatically mean that you have COVID-19. However, these may be the early symptoms.

Those who wish to reduce their risk of COVID-19 or its gastrointestinal manifestation should follow COVID-19 appropriate behaviour. Getting vaccinated, wearing a mask, maintaining personal hygiene, and physical distancing are proven ways of reducing the risk of COVID-19 infection.

Nevertheless, people who have already contracted COVID-19 can follow these measures to avoid or prevent the worsening of digestive problems:

• Increase intake of fluids

GI symptoms of COVID-19 such as diarrhoea and vomiting can lead to dehydration which can further worsen the digestive problems. People with COVID-19 should increase their intake of rehydrating fluids. ORS (oral rehydration solution), fruit juices, and coconut water are some of the good options that can be considered for rehydration.

• Consume a bland diet

COVID-19 patients with GI symptoms should eat foods such as white rice, bananas, oats, boiled potatoes, etc. These foods will help replenish carb levels and limit their bowel movements. Also, avoid spicy, fried, and processed foods that can irritate or inflame the lining of the intestines.

• Use a separate washroom

Exposure to the faeces of COVID-19 patients can increase the risk of COVID-19 and its associated digestive disorders. Those who already have COVID-19 should ideally use a separate bathroom to prevent the risk of spreading illness to others.

When to contact your physician

In most cases, the GI symptoms of COVID-19 will resolve on their own with at-home rest and treatment. However, people who are experiencing the following symptoms should consider  getting medical attention:

• Severe dehydration
• Bloody or blackish diarrhoea
• Severe abdominal pain
• High fever
• Shortness of breath.

Conclusion

In its wake, the second wave of COVID-19 has triggered a significant increase in the number of patients reporting digestive or gastrointestinal problems. Researchers say that the SARS-CoV-2 virus that causes COVID-19 uses the same mechanism to enter and infect the intestinal cells that it uses to bind to cells in the respiratory system. In most cases, the digestive problems caused by COVID-19 are relatively mild. However, some people may experience severe digestive problems such as colitis (intestinal inflammation), gastrointestinal bleeding, and worsening of irritable bowel disease (IBD). Such people should consult a gastroenterologist immediately.

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