https://www.wjgnet.com/1007-9327/full/v27/i43/7433.htm

I saw yet another case this week and decided that it would be appropriate to write a little bit about it, although, as we transition from COVID pandemic to COVID endemic, everyone is really sick about the bug and wants to silence any mention of it. But the lingering effects are still very real for some folks.

Prolonged COVID symptoms can take on many forms, and certain symptoms such as fatigue, brain fog, joint inflammation and breathing difficulties have taken up the most attention. Prolonged GI symptoms have been below people’s radar but I find them to be quite prevalent once you ask patients about it.

The review article in the World Journal of Gastroenterology is far from complete, and will have its share of successor articles over time as data solidifies. However the problem is real and the authors are putting forth some interesting hypothesis for the mechanism: shift in the normal gut ecology, persistent immune irritation, post viral inflammation, and damage to the intestinal lining, and autonomic nerves. To that list I would add the harmful effect of several medications used for acute COVID treatment, such as steroids and Ivermectin, both of which are known to take down beneficial bacteria.

From the experience I have had with patients in the last three months especially, there is no one size fits all approach to recovery. You need to sit down and more specifically evaluate individual symptoms to see if a pattern of GI disruption clearly emerges, and if not, run some testing. Treatment will often involve a combination of GI rest diet, identifying and eliminating irritating foods, treat continued viral and other secondary infections, restore normal microbiome and GI lining and calm down a hyperactive mucosal immune system.