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Covid-19 can cause disorders of the gut-brain interaction, including irritable bowel syndrome, researchers say.
Gastrointestinal symptoms are common in prolonged covid-19, also known as post-covid-19 syndrome, according to physicians Dr. Walter Chan and Dr. Madhusudan Grover.
The Doctor. Walter, assistant professor at Harvard Medical School, and Dr. Madhusudan, associate professor of medicine and physiology at Mayo Clinicboth in the United States, carried out a review of the literature on the chronic gastrointestinal effects of covid-19.
The review was published on August 6 in the journal Clinical Gastroenterology and Hepatology.
According to the authors, estimates of the prevalence of gastrointestinal symptoms in covid-19 reach 60%, and these changes may be present in patients with prolonged covid-19, a syndrome that persists for four weeks or more.
In a survey of 749 Covid-19 survivors, 29% reported at least one never-before-seen chronic gastrointestinal symptom. The most common symptoms were heartburn, constipation, diarrhea and abdominal pain. Of the patients with abdominal pain, 39% had symptoms that met the Rome IV criteria for irritable bowel syndrome.
Individuals with gastrointestinal symptoms after initial SARS-CoV-2 infection are more likely to have these same symptoms in prolonged COVID-19. The presence of psychiatric comorbidities, hospitalization, anosmia and ageusia are predictors of gastrointestinal symptoms.
Infectious gastroenteritis may increase the risk of disorders of the gut-brain interaction, especially post-infection irritable bowel syndrome, the researchers wrote.
Covid-19 is likely to cause gastrointestinal symptoms through several mechanisms. The infection can suppress the angiotensin-converting enzyme 2, which protects intestinal cells, alter the microbiome, and cause or worsen weight gain and diabetes. It can also disrupt the immune system and trigger an autoimmune reaction, cause depression and anxiety, and alter eating habits.
To date, there are no specific treatments for the gastrointestinal symptoms associated with prolonged COVID-19, so clinicians should utilize well-established therapies for disorders of the gut-brain interaction, the researchers recommended.
In addition to adequate sleep and physical activity, treatment may include diets high in fiber, low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols, gluten-free, low-carbohydrate or exclusion diets.
For the treatment of diarrhea, the researchers listed the following options: loperamide, ondansetron, alosetron, eluxadoline, antispasmodics, rifaximin, and bile acid sequestrants.
For constipation, they mention fiber supplements, polyethylene glycol, linaclotide, plecanatide, lubiprostone, tenapanor, tegaserod, and prucalopride.
To modulate intestinal permeability, the authors recommended glutamine.
Neuromodulation can be achieved with tricyclic antidepressants, selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, azapirones, and delta ligands, the authors wrote.
Regarding psychotherapy, they recommended cognitive behavioral therapy and gut-targeted hypnotherapy.
Some studies suggest benefits of bacteria Lactiplantibacillus plants e Pediococcus acidilactici as probiotic therapies. Additionally, one study showed positive results with a high-fiber formula, perhaps by nourishing short-chain fatty acid-producing bacteria, the authors wrote.
Clin Gastroenterol Hepatol. Published on-line on August 6, 2022. Full text
The Doctor. Walter reported financial ties to the companies Ironwood, Takeda e Phathom Pharmaceuticals. The Doctor. Madhusudan reported financial ties to the companies Takeda, Donga, Alexza Pharmaceuticals e Alpha sigma.
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