How a Covid infection you had months ago could trigger chronic nausea and diarrhoea
A Covid infection can trigger chronic nausea and diarrhoea – even months later, writes Angela Epstein
FOR the past two and a half years, Abbey Robb has had to take "precautions" every time she leaves the house.
Having been plagued by stomach problems — including bouts of uncontrollable diarrhoea — since catching Covid in September 2020, the 44-year-old clinical hypnotherapist now makes sure she has eaten very little before heading out, and has gone to the loo.
Yet despite her taking these pre-emptive measures, in early 2021, the 10-minute walk to her local supermarket turned into a horribly humiliating experience.
"I still cringe when I think about it," recalls Abbey.
"I was only five minutes from home on my way back when I suddenly experienced an overwhelming and unstoppable need to go. Every step home felt as if it took forever — I still don’t know how I made it."
The long-term impact of Covid has been a "nightmare", she says. As well as diarrhoea, she suffers from sporadic vomiting, nausea and heartburn — none of which she suffered from before catching the virus.
"As a single woman trying to work, enjoy a social life and date, it has been absolutely awful," she reflects.
"It’s a battle to stop it taking over my life."
And she is not alone. New research suggests that 36 per cent of people who have had Covid are at an increased risk of developing gastrointestinal (GI) disorders such as diarrhoea and nausea within a year of infection, compared with people who haven’t had the virus.
The findings were based on the medical records of 154,068 people who have had Covid, which were compared with 5.6 million records of those without the virus.
The researchers, from Washington University in the United States, estimate that the virus has contributed to more than six million new cases of GI disorders in the US and 42 million new cases worldwide.
A 2020 study by St George’s Hospital in south west London produced similar results. The researchers found that around 100 days after being discharged following admission to hospital for Covid, 16 per cent of patients reported new GI symptoms at follow-up appointments.
While Covid is primarily a respiratory illness, triggering symptoms such as fever, cough and shortness of breath, it is widely accepted that it can also cause diarrhoea, nausea, vomiting and abdominal pain in some patients.
A 2020 analysis of 60 studies involving 4,243 patients found that 17 per cent of Covid sufferers had GI symptoms.
However, how Covid causes long-term gastric problems is not yet understood.
"The exact mechanism of how Covid impacts the stomach is currently being investigated in several trials," explains Dr Mark Faghy, an associate professor in respiratory physiology at Derby University, who is researching recovery patterns in people with long Covid.
"It’s most likely due to the virus spreading throughout the body — including to the gut — through the bloodstream."
Another possible explanation is that the immune system becomes ‘confused’ by the virus and starts attacking itself, including the gut (as it does with other inflammatory bowel conditions), adds Danny Altmann, a professor of immunology at Imperial College London and a trustee of the charity Long Covid Support, which provides help for those affected.
Or it could be a post-viral reaction, causing symptoms of irritable bowel syndrome (IBS) to kick in after the acute infection.
"We know that people sometimes develop erratic bowel conditions after having a bug and then have continual flare-ups," explains Dr Chuka Nwokolo, an honorary professor of gastroenterology at University Hospital Coventry.
"Maybe a proportion of patients with post-Covid syndrome are experiencing this."
Long Covid is defined as symptoms that last longer than 12 weeks after the initial infection.
More than 200 long Covid symptoms have been recorded, according to a 2021 study by University College London, and as many as two million people in the UK are thought to be affected.
Around 700,000 people have been diagnosed in the past 12 months, says Professor Altmann.
Abbey caught Covid after flying home from the Netherlands, where she had been visiting a friend. Her initial symptoms were sneezes and sniffles.
But as the weeks progressed, she found she developed chronic fatigue and breathlessness as well as a range of stomach problems such as sickness and diarrhoea, which interrupted her work for months.
"When I finally had an appointment with my GP — online — several weeks after first developing symptoms, he told me that by this point the virus wouldn’t show on a test but he was certain I’d had Covid and put it down as such on my file," she says.
"He told me there was no treatment, which was frustrating since the symptoms — particularly the gastric ones — were awful.
"It felt like I had permanent IBS and I also developed reflux. And the symptoms seemed to go on day after day."
Abbey’s GP didn’t think her GI symptoms were Covid-related, but when they failed to improve he referred her for a colonoscopy in September 2021 — this procedure involves a tiny camera being inserted into the bowel to check it. However, there were no signs of any abnormalities.
To alleviate her symptoms, Abbey was prescribed omeprazole — a type of proton pump inhibitor (PPI) that reduces the amount of acid produced by the stomach.
This helped "but there would still be days when I was totally knocked out or running to the loo," she says.
"I had to rely on supermarket deliveries because I couldn’t leave the house."
It is important that if you experience a prolonged change in bowel habits, you get them checked out, says Dr Nwokolo.
"The universal advice is not to self-diagnose but see a GP to ensure there is no alternative GI diagnosis."
Once other potential causes have been ruled out, the treatment for post-Covid gut depends on the symptoms, says Dr Steven Mann, a consultant gastroenterologist at the Royal Free NHS Trust in London.
"That can mean dietary advice, anti-diarrhoea medication or the use of probiotics to improve gut flora [an infection can upset the balance of good bacteria, causing symptoms such as diarrhoea]," he says.
"If quality of life is being seriously compromised, we might consider something to calm down the gut nervous system, such as a low dose of the drug amitriptyline.
"This is known as a neuromodulator [normally used to treat depression] that 'resets' the thermostat to reduce gut sensitivity and so help with symptoms."
Abbey, meanwhile, has had to learn to work around her symptoms.
"I do a lot of work on Zoom, which means I can be at home," she says.
"But on days when I see clients in person, I strongly monitor my diet — I may not eat the night before.
"I take a lot of probiotics, make fermented food such as sauerkraut to create good bacteria in the gut, and I stick to plain foods such as vegetables and fruit — nothing processed.
"I’ve come to realise that if I want to feel well, I just have to be so careful about what I eat.
"If I stick to foods I know I can tolerate, I feel better some of the time. But it isn’t always the case. As a therapist I know how to draw on reserves to cope with this — but it’s not a great way to live."
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