Covid Post-Infectious Dysmotility: A Serious Gastrointestinal Issue

Ask a Doc: Impact of COVID-19 on the Gastrointestinal System

The coronavirus has played a big role in our lives for months, so we spoke to Dr. Patrick Okolo III about how it affects the gastrointestinal system.

Rochester Regional Health

Ask a Doc graphic for COVID-19 and GI

The gastrointestinal tract (GI tract) is a series of hollow organs that join together to form a long, twisting tube from your mouth to your anus. The mouth, esophagus, stomach, small intestine, large intestine, and anus make up your GI tract and are part of your digestive system.

Your digestive system is comprised of the GI tract, along with the liver, pancreas, and gallbladder. Every part of your digestive system works to either move food and liquid through your GI tract, break them into smaller parts, or both, to then be absorbed.

We spoke with Patrick Ikemefuna Okolo III, MD, Gastroenterologist at Rochester Regional Health to learn more about the important functions GI tracts play in our lives, and how COVID-19 can affect them.

Q: What GI symptoms have you seen in patients diagnosed with COVID-19?

The most prevalent symptom is the loss of appetite or anorexia. The second most common is upper-abdominal or epigastric (the area right below your ribs) pain or diarrhea, and that has happened with about 20 percent of patients with COVID-19.

Q: What effects can COVID-19 have on the gastrointestinal system?

The GI tract’s major job is to transport nutrients from north to south. COVID-19 disrupts that function and makes it more difficult for the body to absorb fluid and electrolytes. This is often temporary and can resolve on its own, but it can also lead to other harmful problems.

I’ve seen quite a few patients with gastrointestinal bleeding. This makes their care difficult, both from the treatment and infection-prevention standpoint. It also causes liver disease and abnormal liver chemistries. When patients have both abnormal blood tests and typical COVID-19 symptoms, it may lead us down the diagnostic path of chasing after things that are not COVID-related. Given both personal experience here in Rochester and world-wide experience, COVID-19 clearly has a big gastrointestinal footprint.

Q: Are people with pre-existing GI problems at a higher risk for COVID-19?

Yes, because they’re more likely to come in contact with or be in an area where COVID-19 is present. However, patients with pre-existing conditions are more at risk for serious outcomes due to COVID-19.

Q: What implications does COVID-19 have for someone with ulcerative colitis or Crohn’s disease?

One of the biggest concerns is that a number of these patients are treated with agents that suppress their immunity. Because patients with ulcerative colitis or Crohn’s disease have a heightened immunity against their own intestines, we treat them by bringing down their immunity using steroids which decreases their over-active immune system. This increases their potential risk of getting an infection like COVID-19.

Patients who have these conditions may have significantly worsened diarrhea if they develop COVID-19. It’s like having a problem on top of a pre-existing problem, causing a significant physiologic derangement. For these patients, prevention is worth so much and we must spend a significant amount of effort trying to prevent them from getting COVID-19.

Q: Can COVID-19 travel through the digestive tract?

When we look at an example out of China and some of the data from Italy, we found that, yes, we can recover parts of the virus, sometimes even the whole virus, from the stool. This is especially true in the early parts of the illness. What hasn’t been shown, however, is human-to-human spread via stool. Whether it can spread in an oral-fecal way is less clear. Of course, there should be no reason to expose yourself to someone else’s stool. If you do work in and around stool, like digestive disease professionals or laboratory professionals, it’s important to use proper PPE to prevent contact with the virus.

Q: How do I know if my symptoms are from COVID-19?

You can’t know without a test. All patients who undergo procedures at Rochester Regional Health are being tested for the presence of the Cov-2 virus. There are many things that can manifest as COVID-19, and the only way to differentiate is to take a test.

Learn more about testing at Rochester Regional Health

Q: What long-term effects could COVID-19 have on a person’s digestive tract?

While it’s still early days, we have some knowledge of what virus may do to the gastrointestinal tract. In recent years, we’ve come to understand that a coronavirus may run its course, but then patients are left with a digestive tract that no longer behaves as it did before. This is what we call “post-infectious dysmotility.”

With post-infectious dysmotility, the infection is gone, but it continues to manifests by either moving too often or not often enough. Digestive tracts are usually predictable, but a virus can cause irregularity which can cause problems.

COVID-19 might have the same impact, but it’s still too early to know for certain what the impact will be.