COVID and the GI Tract

Covid is the new great masquerader. It can present in many different ways. When it first presented in China in late 2019, most symptomatic patients had fevers and shortness of breath. The initial Wuhan population reported very few gi symptoms. In fact less that 5 percent experienced nausea, vomiting and diarrhea. But the U.S. experience has been quite differet. Approximately 15 percent of patients with symptomatic Covid experience gi symptoms such as nausea, vomiting, and diarrhea.

In fact, in my own experience, I observed several patients with nausea, vomiting, and 10 pound weight loss over 2 weeks. These symptoms did resolve in all cases, but the weight loss is worrisome.

Why did these patients get these symptoms? Because in addition to the lungs, Covid invades the small intestine. In the duodenum there are many receptors which the virus can invade. Once this happens, patients can have delayed gastric emptying which can cause nausea, vomiting, and weight loss.

Anecdotal evidence in China showed that poorer patients taking Pepcid did better than rich patients taking Prilosec. Currently, Northwell and other intitutions have ongoing trials to see if Pepcid helps treat Covid.

My advice, if you have symptoms that persist more than 2 weeks, see your doctor.
Stay safe and wear a mask.

Jeffrey Crespi, MD, MBA, AGAF