Addressing post-COVID-19 gastrointestinal symptoms

When you think about COVID-19 symptoms, cough, fever or shortness of breath might come to mind. However, many COVID-19 patients suffer from gastrointestinal (GI) symptoms in addition to (or instead of) respiratory symptoms.

“Early on, the CDC list of COVID-19 symptoms did not include gastrointestinal symptoms,” said Dr. Jordan Shapiro, assistant professor of medicine – gastroenterology at Baylor. “It became clear after the first few months that there is a subset of COVID-19 patients with non-respiratory symptoms. We now know that subset is about one-third of COVID-19 patients.”

Gastrointestinal symptoms of COVID-19 can include loss of appetite, diarrhea, nausea and vomiting and abdominal pain. However, not all patients with COVID-19 and GI symptoms have symptoms at initial presentation, according to Shapiro. Some patients will develop symptoms several days into or even after the initial infection has cleared.


Shapiro has seen patients at the Baylor Medicine Post COVID Care Clinic who have recovered from COVID-19, but experience ongoing loss of appetite, nausea, acid reflux, diarrhea, bloating and abdominal distension.

“Some people don’t immediately realize that their GI symptoms coincided with their COVID-19 infection, and they may not think the symptoms are related to COVID-19 because they’re not respiratory in nature,” Shapiro said.

Post-infectious GI issues are common after other non-COVID-19 viral or bacterial infections, and some patients experience post-infectious irritable bowel syndrome or gastroparesis. Those symptoms tend to have good long-term prognoses, with the majority improving over weeks, months or less commonly, years.

Researchers believe COVID-19 causes GI symptoms, in part, because the ACE2 receptor used by the SARS-CoV-2 virus to infect cells, is found throughout the GI tract. It remains unclear if the duration of post-COVID GI symptoms will mirror that of other post-infectious GI conditions or not.

Shapiro says mild GI symptoms can usually be treated with over-the-counter medication. But he encourages any patients experiencing persistent GI symptoms to see a gastroenterologist, even if they are unsure if the symptoms are related to a COVID-19 infection.

“We can test for other contributing factors to the GI symptoms with a variety of tests from blood and stool samples to breath tests to radiology testing and occasionally endoscopy,” he said. “If everything comes back normal, we have a variety of treatments for the symptoms. There’s no reason to suffer in silence.”

To learn more about the Post COVID Care Clinic or to schedule an appointment, visit the website or call 713–798–2400.

-By Molly Chiu

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