Can the Coronavirus Cause Diarrhea?
By now you probably know the common coronavirus symptoms by heart: fever, cough, shortness of breath. But some research now suggests it's also possible for the virus to cause diarrhea, vomiting, and other digestive symptoms.
A new study published in The American Journal of Gastroenterology looked at the prevalence of digestive symptoms in confirmed coronavirus cases. Of 204 patients in China who had the virus, 48.5 percent had initially checked in to the hospital with a digestive issue, not a respiratory one, as their main concern, according to the research. The most common digestive symptom among the group was a loss of appetite, followed by diarrhea, vomiting, and stomach pain, report the study authors. Researchers also observed that those who experienced digestive symptoms tended to have worse outcomes and a higher risk of mortality compared to people with no digestive symptoms, possibly because those with digestive issues weren't diagnosed with the COVID-19 infection as promptly, the study authors speculated in their paper.
The study authors offered a few possible reasons why COVID-19 might cause digestive symptoms: For one thing, the coronavirus is believed to bind to cell receptors called ACE2. The liver then seems to react by creating new cells, possibly increasing the number of ACE2 receptors and, as a result, liver tissue injury, according to the study authors' research. Another possibility is that the virus may throw gut bacteria out of whack, leading to digestive symptoms. Yet another potential explanation could be that the virus triggers an inflammatory response from the digestive system, according to the study. (Related: Does Ibuprofen Really Make the Coronavirus Worse?)
"Clinicians should recognize that digestive symptoms, such as diarrhea, may be a presenting feature of COVID-19," and that these digestive symptoms may present either before or in the absence of the traditional respiratory symptoms, the study authors concluded. But they also acknowledged that additional research is needed, particularly with a larger subject pool, to confirm the link they observed between COVID-19 and digestive issues.
That said, given what we know so far, it's too soon to say that people experiencing digestive issues should take the same steps they would if they were experiencing respiratory symptoms, says Andrea Culliford, M.D., a gastroenterologist with Medical Offices of Manhattan. "This is in no way to discredit the efforts of the hard-working clinicians and research teams conducting this study," says Dr. Culliford. "However, more and more data is collected every day, and from our understanding, the signs [of COVID-19] are flu-like." (But, FWIW, flu symptoms can sometimes include digestive issues like diarrhea and vomiting.)
To that end, not all research on COVID-19 suggests that digestive symptoms are significantly prevalent in people with the coronavirus. In another study of COVID-19 symptoms, published in the New England Journal of Medicine, diarrhea was "uncommon" among people who were confirmed to have the coronavirus. Of 1,099 patients from China, only 3.8 percent said they experienced the symptom and 5 percent reported nausea or vomiting.
What about people with pre-existing digestive conditions?
At this point it "remains unknown" whether people with pre-existing digestive issues are more likely to have worse outcomes should they get the coronavirus, according to a paper published in The Lancet. But the paper's authors note that immunosuppression is an important factor to consider here. Case in point: While data from the IBD Elite Union (which comprises some of the largest IBD referral centers in China, including more than 20,000 patients with IBD) suggests there are currently no known patients with inflammatory bowel disease (IBD) who've been diagnosed with COVID-19, the fact that people with IBD are often prescribed immunocompromising medication for their condition could mean they're at a higher risk of experiencing severe complications from a COVID-19 infection—not necessarily because of IBD itself, but because of the immunocompromising medicine often used to treat IBD, according to the paper in The Lancet. Again, though, this data is inherently limited since it only includes people from China who've been infected with COVID-19. (BTW, here are more important deets about the link between coronavirus and immune deficiencies.)
Bottom line: Regardless of whether you're experiencing symptoms (respiratory, digestive, or otherwise), social distancing is a must right now to help slow the spread of COVID-19, according to the Centers for Disease Control and Prevention (CDC). In the meantime though, if you're experiencing fever, cough, or shortness of breath and think you've been exposed to the novel coronavirus, the CDC recommends calling your doctor ASAP and following their instructions.
As for digestive symptoms, at this point you can follow normal protocol when it comes to seeking treatment for these types of ailments, says Dr. Culliford. (Here's a helpful breakdown on how to deal with stomach pain, gas, and other common digestive issues.)
"Unfortunately, the medical community is learning the behavior of COVID-19 day by day," explains Dr. Culliford. "We work very hard to keep patients safe from potential harm. For now, our recommendation is to follow the CDC, WHO, and your state's DOH guidelines until more information is obtained. Perhaps as we learn more, with tests becoming readily available, we can study more about COVID-19 GI symptoms."
The information in this story is accurate as of press time. As updates about coronavirus COVID-19 continue to evolve, it’s possible that some information and recommendations in this story have changed since initial publication. We encourage you to check in regularly with resources such as the CDC, the WHO, and your local public health department for the most up-to-date data and recommendations.