BENGALURU: The SARS-CoV-2 virus which causes Covid-19, may have changed tack, causing gastrointestinal symptoms first in many patients, unlike in the past when fever, cough, breathlessness were the primary indicators of the disease.
Although diarrhoea and gastrointestinal (GI) symptoms were seen during the first wave, this time round, the number of patients reporting such complaints is significantly higher, some doctors say. However, others disagree.
“We have come across several patients with symptoms such as loose stools, abdominal discomfort, etc. Earlier, we saw about 2 per cent of Covid patients with GI symptoms, but now the number has gone up to 50 per cent. Recently, it was found that GI symptoms precede respiratory symptoms. Covid-19 must be suspected in such cases,” said Dr Bindumath P L, senior consultant for internal medicine at Aster CMI Hospital.
When Covid-19 broke out, it was considered a disease that primarily affected the lungs. But, in the past year, doctors the world over have reported that it affects a range of organs including the digestive system. A study done in the UK in October suggested that any part of the digestive system may be affected by SARS-CoV-2 and people with pre-existing diseases are at greatest risk of adverse outcomes. It also found that some repurposed drugs used against the virus can cause or aggravate some of the Covid-related gastrointestinal symptoms and can induce liver injury.
Dr Pavithra, consultant for internal medicine at Columbia Asia Hospital said Covid infections last longer in people who develop GI symptoms as they get diagnosed late. “Covid patients who get gastrointestinal symptoms have more virus in the gut. The number of ACE2 receptors (which bind to the spike protein of the virus) is higher in their small intestine, duodenum and colon than in the lungs and this leads to potentially greater damage on the gut mucosa,” she said.
Such patients could also develop other Covid-related complications, Dr Bindumath said. “Due to the GI involvement, the loss of intestinal barrier and gut microbes can activate immune cells to release proinflammatory ctyokine that will further lead to systemic complications in the respiratory system resulting in respiratory failure and multi-organ failure. People with loose stools and abdominal discomfort should be monitored because it can be Covid,” he said.
However, infectious diseases consultant at Fortis Hospitals, Dr Pruthu Narendra Dhekane, said, “There isn’t a stark difference in the range of symptoms between the first and second waves. What has changed is the rate of transmission. We now see more family members and contacts of patients testing positive.”