Saheb F (September 28, 2026) Post-COVID Gastrointestinal Symptoms and Disorders of Gut-Brain Interaction: A Focus on Persistent Diarrhea. Cureus 18(9): e117111. doi:10.7759/cureus.117111
A research paper was published in ‘Cureus' journal on 28th September which reviews the current situation regarding gastrointestinal symptoms in Long Covid – especially in relation to factors involved in the causation of persistent diarrhoea and the management options that are available.
AI Summary
- COVID-19 can cause long-lasting digestive problems. These can include diarrhea, stomach pain, nausea, constipation, and indigestion.
- Diarrhea is one of the more common symptoms. About 10% of people with long COVID in one large review reported diarrhea.
- Not everyone with diarrhea after COVID has IBS or another gut disorder. Diarrhea after COVID can have many different causes, so doctors need to investigate it carefully.
- Some people develop IBS or functional diarrhea after COVID. However, these conditions appear to affect a smaller number of people than the overall group experiencing GI symptoms.
- COVID may affect the gut in several ways. Possible effects include changes to the gut lining, immune system, gut bacteria, and communication between the gut and brain.
- The gut bacteria may change after COVID. Some studies found fewer beneficial bacteria and changes in substances made by gut bacteria. However, researchers do not yet know whether these changes actually cause long-term diarrhea.
- The virus may remain in the gut in some people, but this is not proven to cause chronic diarrhea. Finding viral material does not necessarily mean that live virus is still present.
- Doctors should rule out other causes of diarrhea first. These can include infections, medication side effects, inflammatory bowel disease, celiac disease, and other digestive conditions.
- There is not yet a specific proven treatment for post-COVID diarrhea. Research on probiotics, synbiotics, and fecal microbiota transplantation is still limited.
- Current treatment is similar to treatment for other types of chronic diarrhea or IBS-D. This may include staying hydrated, reviewing medications, changing the diet, and using medicines to control diarrhea when appropriate.
- More research is needed. Researchers need better studies to understand why some people develop long-term digestive problems after COVID and which treatments actually work.
- Main takeaway: COVID-19 can lead to ongoing digestive symptoms, including diarrhea, but the exact cause is still unclear. Doctors should look for other causes first and then treat the symptoms based on the person's specific condition.
MEA Comment
Gastrointestinal symptoms are common in both Long Covid and ME/CFS.
In relation to ME/CFS, these often involve irritable bowel type symptoms such as abdominal pain, bloating and changes in bowel habit.
Some people with ME/CFS also have gastroparesis – a condition where there is a delay in food and liquids moving through the stomach. This causes a premature feeling of being full after eating – sometimes accompanied by nausea.
The situation in Long Covid appears to be more complicated because gastrointestinal symptoms here may be related to inflammation in the bowel – where diarrhoea can be a significant problem. And there is some research evidence to indicate that there could be pockets of persisting Covid infection in the gut in Long Covid.
This is a review of the current situation regarding gastrointestinal symptoms in Long Covid – especially in relation to factors involved in the causation of persistent diarrhoea and the management options that are available.
Dr Charles Shepherd,
Trustee and Hon. Medical Adviser to the ME Association,
Member of the 2018-2021 NICE guideline on ME/CFS committee,
Member of the 2002 Chief Medical Officer's Working Group on ME/CFS
