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COVID-19 and the GI System

Back in August 2020, we first explored how a COVID-19 infection could affect your GI system. There was very little data to work with at the time, as the pandemic was largely still unfolding across the United States and across the world. 

Since then, much has happened with the pandemic. Now, at a time when vaccinations are widespread in the United States, case counts are ever decreasing, and more of the country starts to open back up, we’re going to take another look at the evidence around COVID-19 and its effects on the GI system. Here’s what the best evidence shows today. 

GI Symptoms in People with COVID-19

Over the past year and a half or so, well over 100 million people around the world have gotten the coronavirus. Researchers have been able to perform numerous studies to examine different aspects of the disease and its impact on communities globally. One study published in September 2020 found that 53% of people hospitalized with COVID-19 experienced at least one GI symptom. 

In our previous post on COVID-19, we noted that research on COVID-19 patients who were ill in March and April of 2020 found several common symptom clusters. One of these clusters was primarily characterized by GI symptoms, and several others included GI symptoms. 

Disease Outcomes when GI Symptoms are Present

An emergent insight from the past year and a half of research is that people with COVID-19 who have GI symptoms seem to be more likely to have more severe disease outcomes. A number of different studies, each focusing on different populations, have found the following: 

Why COVID-19 Causes GI Symptoms

Clearly, the coronavirus attacks the body in a way that implicates the GI system. Scientists have learned more about exactly how this happens, and thus why GI symptoms seem to be fairly common and significant. 

The coronavirus infiltrates cells in the intestine through the ACE-2 receptor, which is a protein in cell membranes. The virus’ spike proteins bind to this receptor and enter the cell. Once in the cell, the virus reproduces itself. When it leaves infected cells, it causes a release of cytokines, proteins that help fight inflammation in your body. When the virus causes too many cytokines to be released, they can damage your GI system and cause symptoms. The coronavirus can also attack your GI system directly in other ways. It may damage tissues, disrupt your gut microbiota, and impact your vagus nerve (which can lead to nausea).   

We hope this overview sheds some light on the recent discoveries of how COVID-19 impacts the GI system.

Our experienced team at GHP has years of experience treating patients with various GI conditions. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

 

Coronavirus Vaccines: Best Practices for People with IBD

People with Inflammatory Bowel Disease (IBD), such as Crohn’s and Ulcerative Colitis, may have questions about how they should approach coronavirus vaccines. The International Organization for the Study of Inflammatory Bowel Disease (IOIBD) recently highlighted an article titled ‘SARS-CoV-2 vaccination for patients with inflammatory bowel diseases: recommendations from an international consensus meeting.’ In this article, the organization highlights the recommendations related to coronavirus vaccines IOIBD has developed for people with IBD. Here are a few highlights:

1. People with IBD should get a coronavirus vaccine

Overall, there was broad and overwhelming agreement among IOIBD members that coronavirus vaccines are safe and necessary for people with IBD. This consensus was reached through multiple questions that explored IOIBD member opinions on the efficacy and safety of the vaccines for IBD patients.

2. People with IBD should get a coronavirus vaccine as soon as it is possible

Not only does the IOIBD recommend vaccines for people with IBD, they recommend people with IBD receive a vaccination as soon as they are eligible.

3. Coronavirus vaccines, including messenger RNA vaccines, replication-incompetent vector vaccines, inactivated vaccines and recombinant vaccines, are safe for people with IBD

IOIBD members considered the main types of vaccines that may be available for people with IBD. They did this to ensure safety across all vaccines. After review, they broadly agreed that all vaccine types are safe.

4. Coronavirus vaccination shouldn’t be delayed if a person with IBD is receiving immune-modifying therapies

Some people with IBD may be undergoing immune-modifying therapy to suppress an inflammatory response. Still, coronavirus vaccines are safe for them.

5. People with IBD who receive a coronavirus vaccine should be informed that the vaccine’s efficacy can decrease if they are receiving systemic corticosteroids

This is also an important insight for people with IBD. They should receive a coronavirus vaccine when possible. However, if they are receiving corticosteroids to calm a flare-up, the vaccine may be less effective.

Our experienced team at Gastro Health Partners continues to safely provide care for our patients during the coronavirus pandemic. We can help establish the best plan of care for your situation. Visit us online at https://www.gastrohealthpartners.com/ to learn about the options we offer and schedule an appointment today.

Coronavirus and the GI system: What does the evidence tell us?

The coronavirus continues to have an enormous impact on the way we live. Over the past several months, we have begun to learn more and more about the virus. We’ve learned about how it spreads, its symptoms, how to detect it, and potential approaches for vaccines. Crucially, the virus has several documented impacts and features related to the gastrointestinal system. Let’s take a look at the evidence. 

Note: As the medical and public health understanding of the coronavirus continues to evolve, there’s a lot we still don’t know for certain. It’s important to recognize the difference between evidence-based conclusions, emerging evidence without sufficient peer review, and speculation. We will carefully frame each point based on the amount and kinds of evidence supporting it. 

Coronavirus Symptoms Associated with the Gastrointestinal System

The coronavirus can cause a range of symptoms, from a fever to a loss of smell and a headache. We do know that it can cause gastrointestinal symptoms in some cases. These well-documented GI symptoms include loss of appetite, nausea, vomiting, and diarrhea. However, not everyone with coronavirus will experience these symptoms. 

Some interesting emerging research suggests that there may be clusters of symptoms. One of these clusters involves gastrointestinal symptoms. Researchers at King’s College London studied data from around 1,600 COVID-19 patients who logged their symptoms to the research group’s COVID Symptom Study app in March and April. They found six distinct clusters of symptoms from the data: 

  1. Flu-like with no fever. Headache, loss of smell, muscle pains, cough, sore throat, chest pain, no fever.
  2. Flu-like with fever. Headache, loss of smell, cough, sore throat, hoarseness, fever, loss of appetite.
  3. Gastrointestinal. Headache, loss of smell, loss of appetite, diarrhea, sore throat, chest pain, no cough.
  4. Severe level one, fatigue. Headache, loss of smell, cough, fever, hoarseness, chest pain, fatigue.
  5. Severe level two, confusion. Headache, loss of smell, loss of appetite, cough, fever, hoarseness, sore throat, chest pain, fatigue, confusion, muscle pain.
  6. Severe level three, abdominal and respiratory. Headache, loss of smell, loss of appetite, cough, fever, hoarseness, sore throat, chest pain, fatigue, confusion, muscle pain, shortness of breath, diarrhea, abdominal pain.

As you can see, the gastrointestinal cluster includes GI symptoms like diarrhea and loss of appetite. Other clusters also contain GI symptoms. Each cluster was also associated with differing proportions of patients who required hospitalization and breathing support. The escalating severe clusters had the largest percentage of patients requiring significant medical support. 

It’s important to note that while the researchers have replicated their findings with a second 1,000 person data set from June, the research is not peer-reviewed yet. However, this is certainly something to keep an eye on as more data trends emerge. 

Sewage: A Potential Method for Measuring Infection Spread

Early on in the pandemic, evidence emerged from multiple studies showing that people infected with the coronavirus shed viral particles in their poop. Whether the disease can spread through feces is still undetermined. However, there has been growing interest in sampling sewage to determine the extent of disease spread. 

This has been particularly appealing because of the lack of adequate testing in many countries. This has led to a significant undercounting of actual infection numbers. A cross-sectional CDC study conducted across multiple states used serological testing on a convenience sample with people of all ages to identify how many had developed antibodies to the disease. This gave a more accurate picture of how many people have been infected, since the presence of antibodies indicates that a person had been or was currently infected. The study found that actual infection numbers were likely 10 to 12 times higher than reported through testing. Note that large-scale seroprevalence studies like this one are continuing to be conducted to identify likely infection rates, so the results here are preliminary. 

With such a disparity between reported and actual case counts, wastewater sampling offers a convenient and accessible way to identify disease spread in a particular area. Importantly, results are quicker than those from viral and serological tests. This is helpful, timely data that can inform decisions about disease containment in the event of a flare-up. Additionally, it can help researchers see the viral ancestry of the disease, tracking different strains, viral changes over time, and spreading patterns and paths. 

There are drawbacks, though. This kind of sampling can’t prove that an entire population is completely clear of the virus. Another drawback is that we still don’t know how many copies of viral RNA need to be present in a sample for disease to be detected. This means false negatives are possible, as we don’t know the minimum number of copies that trigger detection. A lower count of copies could go undetected with an improper assumption about a minimum. 

Overall, there’s certainly a lot we still have to learn about the coronavirus and the GI system. However, as scientists conduct more and more research, we have a better opportunity to make data-informed decisions at public health, medical, governmental, interpersonal, organizational, and individual levels. 

Our experienced team at GHP has years of experience helping patients with a variety of diseases and conditions. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.