Research on the novel coronavirus shows that an upset stomach – the presence of gastrointestinal tract issues– is a more common COVID-19 symptom than previously thought and could indicate poorer short- and long-term outcomes.
Studies also show that the presence of coronavirus in the gut could mean the virus takes longer to leave the system and could lead to a higher risk of liver injury.
The Centers for Disease Control and Prevention advised that gastrointestinal symptoms typically appear before fever or respiratory signs of illness and one of the more serious complications could result in gastrointestinal bleeding.
Some Studies Show Gastrointestinal Symptoms Are More Common Than Previously Thought & Linked To Poorer Outcomes
The gastrointestinal symptoms of coronavirus include diarrhea, vomiting, nausea, abdominal pain and lack of appetite, according to the CDC.
A study conducted in China found that gastrointestinal symptoms might be more common than previously thought. Instead of the 4% initially suggested, the study found that 11.4% of 651 coronavirus patients presented with GI tract symptoms. In the study’s conclusion, researchers noted, “Attention to patients with COVID-19 with non-classic symptoms should increase to protect health providers.”
Medical researchers attempting to understand why coronavirus appears to cause respiratory and gastrointestinal symptoms conducted studies on coronavirus patients, using nasal swabs and testing their fecal matter. In a commentary published in a British medical journal, they noted that the presence of coronavirus could indicate “an alternative route of infection” and might be the result of “fecal-oral transmissions”:
In over half of the patients, faecal samples remained positive for SARS-CoV2 RNA for a mean of 11 days after clearance of respiratory tract samples. A recent study further confirmed that 8 of 10 infected children had persistently positive viral rectal swabs after nasopharyngeal testing was negative. Importantly, live SARS-CoV-2 was detected on electron microscopy in stool samples from two patients who did not have diarrhoea, highlighting the potential of faecal-oral transmission.
A March 26 study from Cureus also found that “while the virus test of the nasopharyngeal swab switched from positive to negative after the treatment, the rectal swab specimens still tested positive,” suggesting that the virus persists in the GI tract long after nasal swabs can detect it. In that study, the authors noted that fecal testing might be an effective way of determining whether people are truly free from the virus, only exhibiting gastrointestinal symptoms or asymptomatic while the virus is in their GI tract.
Medical Xpress reported that Angiotensin Converting Enzyme 2, or ACE2 – the enzyme coronavirus attacks – is present in the lungs and in the gastrointestinal tract. According to Medical Xpress, multiple small studies of patients with gastrointestinal symptoms led to poorer outcomes: “When they compared them to those without gastrointestinal symptoms, patients had more severe disease, higher fevers and a greater risk of liver injury.”
Even of those with mild cases of COVID-19 and respiratory symptoms, 23% experienced GI issues and more than half (57%) experienced gut and respiratory symptoms and, according to Medical Xpress, “It also took longer for those with digestive symptoms to clear the virus.”
Here’s What to Do if You Have Gastrointestinal Symptoms
Gastrointestinal symptoms can be a clinical feature of #coronavirus, so should not be overlooked. Research led by @PHNurseMichelle of the @CDCgov, @NEJM @IDSAInfo @DrNancyM_CDC https://t.co/4nQRO1FyFe
— MedPage Today (@medpagetoday) February 4, 2020
According to the CDC, gastroenteritis — which means inflammation of the stomach and intestines and is a catch-all term for a group of diseases that cause diarrhea and vomiting — can be caused by viruses, bacteria or parasites. Consuming contaminated food or drinks, touching contaminated surfaces and then your face, not washing hands after using the bathroom and having close contact with a sick person are all ways gastroenteritis can be contracted.
The CDC advises people suffering from gastroenteritis to care for themselves by doing the following:
- Consume large quantities of fluids
- Wash hands thoroughly and often
- Use a different bathroom than other members of a family or group, if possible
- Clean any fecal matter or vomit with a disinfectant
- Avoid preparing or serving food
WebMD also suggests that those who believe they may have coronavirus and have an upset stomach clean and disinfect surfaces thoroughly and eat a bland diet, avoiding spicy foods and instead eating “bananas, white rice, applesauce” and similarly bland foods. WebMD also advises people to reach out to a doctor if they feel severely dehydrated, are producing bloody or black diarrhea, experiencing severe belly pain or feel feverish or short of breath.
Medical Xpress suggests that having a healthy microbiome might help people respond better to the virus should it infect the GI tract:
One group of researchers created a risk score based on biomarkers in the blood that can be increased or decreased depending on the composition of your microbiome. They found that the higher the score, the worse the outcome from COVID-19. This association was stronger for older individuals. It may be that the health of our gut bacteria has a critical role in how our immune system reacts to the disease.
The site suggests eating plant-based foods and natural probiotics, such as kombucha, kimchi and natural yogurt.