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The SARS-CoV-2 coronavirus causes discomfort in the digestive tract – this is not a novelty. Many viruses cause them – in everyday language we often speak of “gastrointestinal flu”. Unfortunately, this can have long-term consequences for some people. Including the so-called Pocovid Irritable Bowel Syndrome.
SARS-CoV-2 coronavirus infection causes gastrointestinal symptoms in as much as 60 percent. elderly patients with comorbidities taking antibiotics.
In this matter, a lot depends on the condition of our intestinal microbiota, which – let us remind you – plays a key role, inter alia, in in the functioning of the immune system. Its proper composition increases immunity, has a significant impact on the milder course of infection, and alleviates abdominal discomfort. It is also visible in the case of SARS-CoV-2: patients with a disturbed microbiota balance (the so-called dysbiosis) have a more severe course of infection, including the pulmonary infection.
– It happens because probiotic bacteria fight the virus. If there are enough of them, the damage to the intestinal barrier is less. Dysbiosis increases the severity of infection – explains prof. dr hab. n. med. Grażyna Rydzewska, head of the Department of Internal Diseases and Gastroenterology of the Central Clinical Hospital of the Ministry of Interior and Administration in Warsaw, president of the Polish Gastroenterological Society. – Studies conducted in patients with COVID-19 confirmed the reduction of such bacterial strains as Lactobacillus and Bifidobacterium. This is due to the better binding of the virus to the angiotensin II receptor, for which probiotic bacteria also compete, and thus increased mucosal permeability, followed by an increase in abdominal symptoms.
A large Chinese meta-analysis (including 60 different studies), including over 4 patients, showed a very significant share of the SARS-CoV-2 virus in gastrointestinal complaints. It shows that 30 percent. people who contracted COVID-19 have appetite disorders, 10 percent. – vomiting and nausea, over 12% – diarrhea, 9,2 percent – abdominal pain.
Pocovid irritable bowel syndrome – causes
The relationship between SARS-CoV-2 infection and abdominal symptoms has been unquestionably confirmed. It has been proven, inter alia, that a previous gastrointestinal tract infection may be a serious risk factor for post-infectious irritable bowel syndrome. It is related to an infection that occurred before and after which the abdominal symptoms persist after its resolution. This applies, inter alia, to patients who have had COVID-19. We are talking then about pocovid irritable bowel syndrome. It is worth knowing that also acute viral infections caused by other pathogens are often one of the factors leading to the development of irritable bowel syndrome.
- Bowel diseases – how to recognize them and how to treat them?
– It should be remembered that the genetic material of the virus may be available in the stool, which is why it is so important to observe the rules of hygiene, because it is also possible to become infected through the digestive system – warns prof. Rydzewska.
Gastrointestinal symptoms are more common in the elderly, suffering from other diseases, with Clostridium difficile infection, using antibiotics and proton pump inhibitors. Many people reach for them with ailments of the upper gastrointestinal tract, such as heartburn, reflux and gastric or duodenal ulcer disease.
– Everything indicates that we must be careful in using them, because their abuse has negative consequences, which are significant in the current pandemic. Also, systemic antibiotics should be recommended more rationally. They are recommended only in the case of prolonged fever, increased inflammatory parameters and suspected bacterial infection – says the specialist.
How to care for the gut microbiota and why?
– The stability of the intestinal microbiota and its proper composition mean not only increased resistance to various infections, but also their milder course, less gastrointestinal symptoms, which usually means safer illness – points out Grażyna Rydzewska.
Microbiota is like a fingerprint – everyone has their own, individual. When its composition is correct, we call it eubiosis, it means the balance of the intestinal microbial ecosystem. Sometimes, however, this balance is disturbed, which entails undesirable consequences, sometimes affecting the entire organism. This condition is called dysbiosis.
However, we can influence the composition of the microbiota. The basis is a good diet that takes care of the integrity of the intestinal mucosa, based on natural products. Both the type and composition of the consumed food are important. It has been observed that high fat content in consumed products causes the growth of Firmicutes and Proteobacteria, and a decrease in Bacterioidetes. Dysbiosis can also be caused by a diet high in carbohydrates and low in fiber. But the number of bacteria is also influenced by the medications used, radiotherapy, chemotherapy, previous infections, and diseases of the gastrointestinal tract. Environmental conditions, place of residence, age and gender play an important role.
– We have many patients who return from exotic trips abroad, e.g. to Egypt, and complain about prolonged symptoms of the so-called pharaoh’s revenge. They look for the causes of ailments by examining themselves for parasites or fungal infections. Meanwhile, it turns out to be a post-infection irritable bowel syndrome, i.e. dysbiosis related to a past infection. The infection is gone, but there are unpleasant effects – says prof. Rydzewska.
Irritable bowel syndrome – where does it come from?
Due to the short time of observation of this phenomenon, it is still unknown how long the post-infectious disorders last – probably about two years, according to specialists. Of course, treatment shortens these symptoms, but it is already known that they last three times longer than in previously uninfected people who did not have abdominal symptoms.
– Until now, patients with irritable bowel syndrome have often been said to be a matter of personality. Meanwhile, this oversensitive personality is associated with dysbiosis, and only targeted treatment, such as that used in irritable bowel syndrome, works. Of course, we often use painkillers, antispasmodics, and even psychotropic drugs, because they have a supporting role. However, the basis is regulating the microbiota and in patients in whom we cannot influence it, the treatment effect is usually relatively small – explains the gastroenterologist.
The restoration of the microbiota is a long-term process. Help in the form of appropriate food, the use of probiotics and prebiotics (but only those that have been proven to be effective in research), and in some patients – also eubiotics, are now the basis of therapy. The patient can do a lot on their own, but it is best if they plan the action in consultation with the doctor.
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The FODMAP diet – for people with intestinal problems
Patients with irritable bowel syndrome are recommended to use the so-called short-term low FODMAP diets (this abbreviation stands for “Fermenting Oligo-, Di-, Monosaccharides and Polyols”), which avoids products containing:
- fructose (found mainly in fruits, honey, sweets in the form of glucose-fructose syrup),
- lactose (found mainly in dairy products),
- fructans (found mainly in wheat, garlic, and onions),
- galactans (found mainly in legumes) and
- polyols (including mannitol, sorbitol, xylitol).
After several weeks of using this diet, the patient is able to notice which foods are better avoided and which he can eat with impunity. In most people, products rich in FODMAP do not cause problems, however, in people with diseases of the digestive system, they may worsen symptoms. As they pass into the intestine unchanged, they contribute to increased absorption (absorption) of water in the small intestine, which can lead to stretching of the intestinal wall and abdominal discomfort (pain, overflow feeling, diarrhea, etc.). When they enter the large intestine and are fermented by the gut bacteria, they create excessive amounts of gas causing pain, discomfort and gas.
- What to eat and what to avoid in irritable bowel syndrome?
Therefore, people with intestinal problems should avoid these products. The purpose of the FODMAP diet is primarily to identify products that may worsen symptoms and those that are well tolerated by patients and to make dietary modifications that would allow for the reduction of symptoms in the long term without applying a restrictive diet. Soluble fiber plays a key role in this diet, it is also necessary to overcome the deficiency of butyric acid, which increases the tightness in the intestinal mucosa and the integrity of the microbiota – advises prof. Grażyna Rydzewska.
A very important condition for the effective elimination of products abundant in FODMAPs is to carefully read the composition of ready products and dishes. It is worth realizing, for example, that garlic and onion are very often added to seasoned meats and ready-made seasoning mixtures. The same is true for products containing artificial sweeteners. Sweeteners are added to products intended for diabetics (yoghurts, juices or sugar-free gums). You should also pay attention to products containing the addition of glucose-fructose syrup: sweets and confectionery products, yoghurts, juices, mustards, ketchup and other ready-made sauces. By reading the labels carefully, you can be sure that the product in question does not contain FODMAPs.
The specialist points out that a good diet – especially in the case of people with intestinal hypersensitivity – is not a temporary whim, but a way of life. And people after suffering from coronavirus infection with abdominal symptoms, whether they like it or not, belong to this group. So they should pay more attention to what and how they eat – it will speed up their recovery.
Monika Wysocka, Zdrowie.pap.pl
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