COVID-19 is a disease that is dangerous not only in the acute phase, but also with its consequences and long-term effects on all human organ systems. The transferred infection requires rehabilitation aimed at the complex restoration of the body and at improving the condition of individual organs.
There are 4 degrees of the course of the disease: mild, moderate, severe and extremely severe. In determining the severity, the key factors are the level of blood oxygen saturation, CT or X-ray results, and associated complications. At particular risk – with a high probability of a severe course of the disease – are the elderly, people with a weakened immune system, as well as patients with the following chronic diseases: cardiovascular diseases, diseases of the respiratory system, diabetes mellitus, obesity [1].
How COVID-19 affects the digestive system
The infection most often presents with respiratory symptoms such as cough, shortness of breath, and sore throat. However, more than a year has passed since the start of the pandemic, and numerous studies and clinical observations have shown that patients infected with SARS-CoV-2 not only have respiratory signs of infection, but also symptoms of digestive disorders, such as diarrhea, vomiting , nausea or abdominal pain [2].
It is known that the digestive tract is the largest human immune organ, the mucosa of which contains about 25% of immunologically active tissue. In addition, approximately 80% of immune cells are located in this organ. The intestinal microbiota plays an important role in maintaining immunity. Therefore, it is extremely important to maintain its healthy condition and correct violations in time. [3].
Can gastrointestinal diseases lead to complications with COVID-19
The researchers specifically highlight the direct impact of COVID-19 on altering the gut microbiota and note reduced bacterial diversity in gut microbiota samples from coronavirus patients compared to healthy controls. Moreover, in patients there is an increase in the number of opportunistic microorganisms and a decrease in the number of beneficial bacteria, including those belonging to the Ruminococcaceae and Lachnospiraceae families. Such changes are considered typical signs of dysbacteriosis. A decrease in the number of beneficial species of intestinal bacteria Faecalibacterium prausnitzii can also aggravate the severity of the disease.
Thus, disruption of the gut microbiome may predispose people (including those not at high risk) to severe COVID-19. At the same time, the transferred infection can lead to violations of the microbial composition of the intestine even in initially healthy people, and this in turn causes pathological conditions. [4].
Relationship between irritable bowel syndrome, bacterial overgrowth syndrome and COVID-19
Let’s consider some pathological conditions of the intestines that can both affect the course of COVID-19 and aggravate the patient’s condition even after recovery. Irritable bowel syndrome (IBS) is a functional disease of the colon characterized by chronic abdominal pain accompanied by changes in stool frequency, stool shape, and other intestinal and extraintestinal symptoms. It should be noted that IBS affects about 20% of the world’s population. Bacterial overgrowth syndrome (SIBO), in turn, is characterized by an increase in the number of bacteria in the small intestine with the development of diarrhea and malabsorption of certain nutrients.
It is important that patients with IBS who underwent COVID-19 are characterized by an imbalance in the microbial composition of the small intestine with the formation of SIBO, which among this group of patients is significantly more common than patients with classic stress-induced IBS. [5]. This is a confirmation of the fact that the coronavirus “hit” the weak points of the human body, making them even more vulnerable. This means that a patient who initially suffers from problems in the work of the intestine, after suffering a COVID-19 infection, receives additional complications associated with this, and the joint work of the doctor and the patient in the fight against both these complications and their original causes becomes an important part of rehabilitation. .
How is rehabilitation going?
The need for rehabilitation after suffering even a mild form of coronavirus was discussed in the first months of the pandemic. Restorative procedures help the patient to return to a state of health as close as possible to the “pre-COVID”. Complex measures are aimed both at restoring the full functioning of the lungs and respiratory function, strengthening the immune system, and at restoring digestion, eliminating chronic fatigue syndrome, and improving the psychological state.
In Russia, programs for rehabilitation from the transferred COVID-19 on the basis of medical institutions are widely used. It can be both outpatient recovery and day hospitals of polyclinics and private medical centers, as well as sanatoriums. Taking into account the fact that such programs take from two weeks, the patient, taking into account his abilities, can choose for himself the best option between undergoing rehabilitation in a sanatorium or clinic.
No unique technology
A universal rehabilitation program after suffering COVID-19 has not yet been presented. In addition, the approach to each patient is always individual. The most important thing is to try to restore the lost functions of vital organs as much as possible.
The general points of rehabilitation are:
- Diet taking into account violations of the patient’s functions of the gastrointestinal tract. Therapeutic nutrition is aimed at restoring digestion, as well as replenishing the deficiency of macro- and micronutrients.
- Medicines. The doctor prescribes the necessary medications and determines the duration of treatment.
- Physiotherapy. Light exercise, moderate physical activity help strengthen muscles, improve respiratory function and blood circulation.
- Breathing exercises aimed at restoring lung function.
- Complete sleep mode. Asthenic syndrome is a common consequence of coronavirus, which is difficult to eliminate. You need to sleep at least 8-9 hours a day. In addition, healthy sleep helps in restoring the psychological state of the patient.
diet therapy
According to the recommendations of the Ministry of Health, during the rehabilitation of patients after COVID-19, it is extremely important to pay attention to the restoration of the function of the digestive organs [6]. A key element of rehabilitation after COVID-19 in patients with impaired bowel function, in particular with IBS and SIBO, will be diet therapy. Patients need to exclude from the diet foods that promote gas formation, stretching of the colon and excessive reproduction of bacteria. According to numerous clinical recommendations of gastroenterologists, these pathological conditions are diagnosed using a hydrogen breath test. [7][8]. The low-FODMAP diet can be used as the main diet.
FODMAP is an abbreviation for “fermentable oligo-, di-, and monosaccharides and polyols”, which means “fermentable oligo-, di- and monosaccharides and polyols”. In other words, these are carbohydrates that are poorly digested and cause fermentation processes in the intestines. Undigested carbohydrates are metabolized by the intestinal flora to produce excess gas, which causes pain in the intestines, promotes diarrhea and/or constipation [9].
There is growing evidence that a low-FODMAP diet is effective in relieving the symptoms of IBS and SIBO. [10]. The use of a low FODMAP diet is currently being investigated for other conditions such as endometriosis, infantile colic, functional dyspepsia, fibromyalgia, scleroderma, and chronic fatigue syndrome. [11].
How to improve the condition of the intestinal microflora
In addition to diet therapy, one of the main methods of treating SIBO is the so-called “sanation” of the intestine by prescribing intestinal antiseptics. Preference is given to non-absorbable (eg, rifaximin) and other antimicrobials that have proven effective. The appointment of pre- and probiotics as additional means of correcting SIBO can reduce some of the symptoms – bloating, abdominal discomfort. Also, in the treatment of SIBO, additional drugs are often used, such as polyenzymatic preparations, intestinal motility regulators, sorbents, etc. However, these drugs are rarely effective as the only therapy, so an integrated approach is needed, based on diet therapy.
Hydrogen breath test
The diet, especially its first stage, is very difficult to follow, since it excludes many foods familiar to humans from the diet. Therefore, the sooner products are identified that the patient can return to his diet, the easier it will be for him. Both in outpatient settings and in rehabilitation conditions in a day hospital, this can be facilitated by a hydrogen breath test.
As mentioned above, the hydrogen breath test is recommended for both the diagnosis of IBS and the diagnosis of SIBO. In addition, with the help of a hydrogen breath test, it becomes possible to monitor the patient’s condition and the effectiveness of the therapy.
Conducting method
The principle of operation of the analyzer is to determine the level of hydrogen in the exhaled air passing through an electrochemical sensor. Measuring the concentration of hydrogen in the exhaled air allows you to assess the level of activity of anaerobic bacteria in the intestine, as well as to identify deviations from the norm. The time during which the hydrogen concentration rises during a breath test indicates the part of the intestine in which fermentation processes take place.
The results of the study
Such an analyzer has already been used in studies at the medical center among patients with IBS and SIBO who had a new coronavirus infection. [12]. The aim of the study was to assess the prevalence of small intestinal bacterial overgrowth syndrome in patients with IBS who recovered from COVID-19. A LAKTOFAN2 device was used as an analyzer of exhaled hydrogen.
Data have shown that SIBO is much more common in IBS patients who have had a novel coronavirus infection compared to patients who have not experienced COVID-19. Diagnostics showed the presence of SIBO in 93,3% of cases in patients with IBS who underwent COVID-19, and the presence of SIBO in only 60% of cases in patients from the control group. This difference clearly demonstrates the impact of coronavirus infection on the deterioration of the intestinal microflora and the occurrence of pathologies.
The presence of such a diagnostic method in a medical institution offering patients a rehabilitation program for COVID-19 can significantly expand the scope of services provided by the institution, help doctors and patients. Thus, starting rehabilitation measures after suffering COVID-19, a patient with indigestion and suspected of having IBS or SIBO will be able to undergo a hydrogen breath test on the first day.
What will it be useful for?
The gastroenterologist will prescribe the necessary treatment for the patient and give recommendations on changing the diet. With the help of a hydrogen breath test, it will be possible to monitor the effectiveness of therapy from the first days of the patient’s rehabilitation. A regular hydrogen breath test in a medical facility is possible both during outpatient rehabilitation and when visiting a day hospital, and this will help to track the dynamics of the restoration of digestive function in the process of recovery after a COVID-19 infection. As a result of such a diagnosis, it becomes possible for the patient, before completing the recovery procedures, not only to assess the current effect of rehabilitation, but also to receive valuable recommendations from the doctor on further treatment and nutrition, since the final recovery from COVID-19 may take several months.
Thus, timely diagnosis of intestinal dysfunctions using a hydrogen breath test in patients who have undergone COVID-19 allows timely adjustment of the diet, prescribing the necessary treatment, which can shorten the recovery period after the disease and significantly improve the quality of life of the patient.
The prognosis for SIBO and IBS, including those that arose after a COVID-19 infection, is favorable. Timely diagnosis and correctly prescribed treatment completely eliminate the symptoms of intestinal dysfunction, lead to recovery and return to a normal lifestyle.
- Sources of
- ↑ Minzdrav.gov.ru. – Answers to frequently asked questions about the new coronavirus infection.
- ↑ PubMed.gov. – COVID-19: Focus on the lungs but do not forget the gastrointestinal tract.
- ↑ Kornienko E.A. – Intestinal microbiota as a key factor in the formation of immunity and tolerance. The potential of probiotics. – Medical advice. – No. 10. – 2020. – S. 92-100.
- ↑ mBio.asm.org. – Do an Altered Gut Microbiota and an Associated Leaky Gut Affect COVID-19 Severity?
- ↑ Scientific and practical journal “University Clinic”. – Features of clinical manifestations of post-infectious irritable bowel syndrome in patients who have undergone COVID-19. / Naletov A. V. and others. – No. 4(37). – 2020 – S. 48-52.
- ↑ Minzdrav.gov.ru. – Interim Guidelines “Medical Rehabilitation for Novel Coronavirus Infection (COVID-19)”.
- ↑ Russian Journal of Gastroenterology, Hepatology, Coloproctology. – Clinical recommendations of the Russian Gastroenterological Association and the Russian Association of Coloproctologists for the diagnosis and treatment of irritable bowel syndrome. / Ivashkin V.T. and others. – No. 27(5). – 2017 – P. 76-93.
- ↑ Crimean Therapeutic Journal. – Modern approaches to the diagnosis of bacterial overgrowth syndrome. / A.P. Balabantseva, I.L. Klyaritskaya. – No. 4. – 2015 – S. 19-27.
- ↑ Elsevier.es. – The low-FODMAP diet for irritable bowel syndrome: Lights and shadows.
- ↑ National Center for Biotechnology Information. – Diet in irritable bowel syndrome: What to recommend, not what to forbid to patients!.
- ↑ World Gastroenterology Organization. – WGO Global Practice Guidelines on Diet and the Gut. – 2018 – 39 p.
- ↑ Naletov A.V. – Prevalence of small bowel bacterial overgrowth syndrome in patients with irritable bowel syndrome who have had COVID-19.