Gastroenterologists say that since the start of the pandemic in 2020, they have noticed an uptick in IBS and other painful and often puzzling gut conditions like Carter’s, with many seeming to have been caused by previous coronavirus infections. We don’t have good estimates for what percentage of people with Covid-19 go on to develop persistent gastrointestinal symptoms, but some limited and small studies suggest they may be between 16% and 40%.
What gut issues can Covid cause?
Gastrointestinal symptoms like nausea, vomiting and diarrhea are common during the initial stages of a coronavirus infection, said Dr William D. Chey, a gastroenterologist at Michigan Medicine. But for some people, these and other symptoms, like reflux, constipation, pain and bloating, can stick around for months or even years.
As was the case for Carter, certain gut symptoms may also disappear and then reappear months later, Chey said. And people who had chronic gut issues before they had Covid may notice that the problems worsened after.
For some people, gastrointestinal symptoms are their only complaint after Covid. But for others, they may be one of a slew of other long Covid symptoms, including fatigue and brain fog, said Dr Louise King, a physician at the Covid Recovery Clinic at the University of North Carolina School of Medicine.
Research suggests that if you had gastrointestinal symptoms during a Covid infection, you are at greater risk of developing gut issues months later. And chronic gut issues after Covid seem to affect more women than they do men.
Beyond the pain and discomfort of these gut symptoms, their unpredictability may make people hesitant to eat out or even to leave their homes, leading to isolation, King said.
How might Covid prompt these issues?
The coronavirus infects your body’s cells by latching on to certain proteins that dot their surfaces. Those proteins are present on the cells of many tissues, including those in the lungs, heart, brain and gastrointestinal tract, so it’s not surprising that the virus can cause digestive symptoms, Chey said.
Doctors have also long known that other gastrointestinal infections, like those from norovirus, giardia and salmonella, can lead to IBS as well as functional dyspepsia, a type of chronic indigestion that causes frequent feelings of fullness and stomach pain or burning. It makes sense that Covid might cause the same kinds of issues, said Dr B. Joseph Elmunzer, a gastroenterologist at the Medical University of South Carolina.
One theory about how Covid might cause these symptoms is that it may ramp up inflammation in the gastrointestinal tract. Covid can also disrupt the gut microbiome, King said, resulting in fewer of the “good” microbes that tamp down inflammation and more of the “bad” ones that cause inflammation.
Over time, inflammation can damage the lining of the intestine, making it more permeable or “leaky”, Chey said. That leakiness may allow molecules from foods to escape from the gut, causing immune cells to mount an allergy-like response to foods.
Covid-induced inflammation may also “chew away” at the nerves that control contractions and pain signals in the gut, said Dr Braden Kuo, a neurogastroenterologist at Massachusetts General Hospital. This might cause the nerves to send pain signals to the brain even when digestion is working normally, he said.
Anxiety and depression often worsen gut symptoms, too. In a study published in May, Elmunzer and his colleagues surveyed people who were hospitalised with Covid-19 early in the pandemic. Compared with those who didn’t experience post-traumatic stress disorder related to their illnesses, those who did were more likely to develop a condition like IBS or functional dyspepsia 12 to 18 months after their hospitalisation.
What treatments are available?
Doctors don’t know how long someone with Covid-related gut symptoms can expect them to last. But for people who develop IBS after other types of gastrointestinal infections, Chey said that about two-thirds will recover within three to five years. In King’s experience with her long Covid patients, most feel significantly better within a year of their infections.
If your symptoms are affecting your daily life, Chey said, it’s worth seeing a primary care doctor. If that doesn’t help, he said, consider an appointment with a gastroenterologist. It’s especially important to see a doctor if you have blood in your stool or unintended weight loss, or if you have a family history of colorectal cancer, celiac disease or inflammatory bowel disease, so that you can rule these and other conditions out.
There are many ways to manage IBS, Chey said. Following a low-FODMAP diet, ideally with a dietitian’s guidance, often helps; or you could try a Mediterranean-style diet, he said. A psychologist who specialises in gut health can help you learn techniques for managing symptoms, he said.
Over-the-counter medications and supplements may address your symptoms, Chey said. These include loperamide (Imodium) for diarrhea, polyethylene glycol (Miralax) or a magnesium oxide supplement for constipation, and enteric-coated peppermint oil (IBgard) for bloating and abdominal pain. There are also prescription medications for IBS that can treat diarrhea and constipation.
For Carter, it has been a long eight months, but with the help of a gastroenterologist, dietitian and gut psychologist, she is gradually improving. She still can’t eat many of her favourite vegetables, but she’s slowly expanding her list of safe foods. It’s like “learning how to eat again”, she said.
She is determined to maintain a positive relationship with food and her body, even though she has, at times, felt it was betraying her.
“I can hate IBS,” she said she tells herself. And “I can hate Covid, but I’m not allowed to hate my body.”
This article originally appeared in The New York Times.
Written by: Alice Callahan
Illustration by: Israel Vargas
©2024 THE NEW YORK TIMES
