COVID-19-induced gastrointestinal autonomic dysfunction: A systematic review
Plain-Language Summary
This systematic review examines how COVID-19 and Long COVID can disrupt the autonomic nervous system that controls the gastrointestinal tract. The autonomic nervous system regulates involuntary functions such as digestion, bowel motility, secretion, and blood flow. When this system is impaired, patients may experience persistent gastrointestinal symptoms including diarrhea, nausea, vomiting, abdominal pain, bloating, constipation, and early satiety.
By analyzing 113 studies published up to April 2023, the authors show that SARS-CoV-2 has a documented ability to affect both gastrointestinal tissues and neural pathways. The virus may damage autonomic control through multiple mechanisms, including direct infection of nerve tissue, immune-mediated inflammation, hypoxia during severe illness, gut microbiome disruption, and prolonged immune activation. These effects can occur during acute infection or persist as part of Long COVID.
The review highlights that although gastrointestinal autonomic dysfunction is relatively uncommon, it can significantly impair quality of life and prognosis when it occurs. Symptoms may be difficult to diagnose because they overlap with many other gastrointestinal and neurological conditions, and effective management often requires coordinated care across multiple medical specialties.
Key Findings
- SARS-CoV-2 can affect both gastrointestinal tissues and the autonomic nerves that regulate digestion.
- Common symptoms include diarrhea (most frequent), anorexia, nausea, vomiting, abdominal pain, bloating, and constipation.
- Mechanisms include direct neural involvement, immune-mediated inflammation, hypoxia, gut dysbiosis, and impaired intestinal barrier function.
- Gastrointestinal autonomic dysfunction can persist beyond acute infection and contribute to Long COVID symptoms.
- Severe disease, older age, prolonged illness, hypoxia, and pre-existing comorbidities increase risk.
- Diagnosis is challenging due to symptom overlap with other gastrointestinal and neurological disorders.
Study Type
Systematic review of clinical studies, observational studies, case reports, reviews, and guidelines.
What This Means (and Doesn’t Mean)
This review supports the idea that gastrointestinal symptoms in Long COVID may, in some patients, be driven by dysfunction of the autonomic nervous system rather than isolated gut pathology. It provides a biological framework linking viral tropism, immune responses, and neural regulation to persistent digestive symptoms.
However, the review does not establish definitive causal pathways, does not quantify how often these mechanisms occur in the general Long COVID population, and does not identify proven treatments. The findings summarize existing evidence but do not provide clinical recommendations or medical advice.
Source
Disclaimer
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