The Sars-CoV-2 virus causing Covid-19 affects all the body organs. ACE-2 receptors (angiotensin converting enzyme -2), to which the virus binds itself, are found in the oral and nasal mucosa, lungs, brain, heart, kidney, gastrointestinal tract, spleen, liver, pancreas, bile duct, gall bladder, small intestine, colon and anus. Several studies have revealed the presence of Sars-CoV-2 RNA in the epithelial cells of the gastrointestinal tract of the infected patient, more prominently so in those who required hospitalization due to severe Covid-19. It was seen that the Sars-CoV-2 virus infects and replicates rapidly (with a 100 fold higher expression, particularly in the colon) in the gastro-intestinal tract and causes long-term damage to the digestive system. Stool samples of nearly 70 % patients were detected as nucleic-acid positive, even long after (up to about a month) their naso-pharyngeal swabs for RTPCR test showed a negative result. Also, Sars-CoV-2 infection in the gut shows a prolonged presence in the body, wherein recovery may be much slower. Moreover, it has also been established that the virus can infect through faecal transmission as well – i.e. exposure to an infected person’s faeces. This significant discovery has led to a better understanding of Sars-CoV-2 virus transmission and infection control.
The following symptoms accompanying other Covid-19 symptoms must not be ignored:
- Diarrhoea and bowel irregularities;
- Abdominal pain;
- Loss of appetite;
- Dehydration due to the obstruction in the body’s inability to absorb fluids due to the infection, thus causing an electrolyte imbalance;
- Elevated hepatic enzymes;
- Blood and/or mucous in stools.
Risks & Complications
- Damaged mucosa in the oesophagus, stomach lining, duodenum and rectum;
- Abnormal liver function due to liver injury, inflammation and damage;
- Intestinal inflammation due to decreased absorption of tryptophan, which may alter gut microbiota;
- Intestinal ischemia (‘dead bowel’ or destruction of bowel tissue) caused by decreased or blocked blood flow in the intestines due to clots blocking the blood vessels/ arteries, which is life-threatening;
- Inflammatory bowel disease;
- Intestinal dysmotility and irritable bowel syndrome;
- Acute haemorrhagic colitis;
- People with pre-existing liver disease, cancer or gastrointestinal disorders like hepatitis, cirrhosis, ulcerative colitis and Crohn’s disease, who are on immunosuppressant medication, may find that the disease has aggravated due to hypoxia (decreased levels of oxygen in the blood) which causes a cytokine storm in the body’s organs;
- Pancreatitis in extreme cases;
- Acalculus cholecystitis in extreme cases.
Blood and Diagnostic Tests
- CBC (Complete blood count)
- Blood albumin
- LFT (Liver Function Test)
- Alkaline Phosphatase
- Stool culture;
- Endoscopy and Trans-nasal endoscopy in severe cases where the oesophagus lining may have gotten damaged and peptic ulcers may have developed;
- Colonoscopy in severe cases where there is gastro-intestinal bleeding.