Gastrointestinal post-acute COVID-19 syndrome

Abstract

The definition of gastrointestinal involvement in post-acute COVID-19 syndrome, its frequency and its pathophysiology are still not completely understood. Here, we discuss the emerging evidence supporting immunological signatures and the unique nature of the gastrointestinal tract in this syndrome.

"SARS-CoV-2 Infection and Gastrointestinal Involvement The Tip of the Iceberg"

“…The acute period or COVID-19, that lasts approximately four weeks [4], is driven initially by replication of SARS-CoV-2 in the cells, that seems to last longer in GI tract cells [5], and then by an exaggerated immune/inflammatory response to the virus that damages tissues [2,6], COVID-19 is a primary respiratory transmitted illness that presents with fever, fatigue, cough, shortness of breath, muscle or body aches, headache, sore throat, congestion or runny nose, loss of taste or smell, nausea, vomiting and diarrhea [7]. GI manifestations are reported in 11.4-61.1% of individuals with COVID-19 (6), and are different across the literature reviewed in frequency, presentation [8,9], onset time [10] and clinical outcome [9].…”

“…Also, elevated FC suggested an inflammatory response in the gut, which was significantly correlated with IL-6 [12]. Furthermore, in the GI tract the microbiota that colonizes it plays a variety of important physiological roles in the body, through multiple recognized axes (brain, lung, estrogen) [4,13], and is altered during SARS-CoV-2 infection. COVID-19 patients had significantly reduced bacterial diversity, a significantly higher relative abundance of opportunistic pathogens (Streptococcus, Rothia, Veillonella and Actinomyces), and a lower relative abundance of anti-inflammatory symbionts compared to non-infected [10,14].…”

“…PACS also known as long-COVID is part of the postacute infection syndromes group, characterized by an unexplained failure to recover from an infectious disease [15]. The majority of manifestations in PACS are systemic, neurological, cardiorespiratory, and gastrointestinal [4]. The gastrointestinal-related symptoms in these patients include loss of appetite, nausea, weight loss, abdominal pain, heartburn, dysphagia, altered bowel motility and irritable bowel syndrome [4].…”

“…The majority of manifestations in PACS are systemic, neurological, cardiorespiratory, and gastrointestinal [4]. The gastrointestinal-related symptoms in these patients include loss of appetite, nausea, weight loss, abdominal pain, heartburn, dysphagia, altered bowel motility and irritable bowel syndrome [4]. The syndrome may develop not only in COVID-19 hospitalized patients and evidence indicates that it can develop regardless of the severity of the original symptoms.…”

“…Common features are viral persistence, a continuous dysbiosis, and aberrant immunological response with a persistent inflammation that can lead to autoimmunity [4,15,16].…”