The infection caused by the SARS-CoV-2 virus, known as COVID-19, is primarily recognized as a respiratory illness, yet its effects extend far beyond the lungs. A significant number of patients experience involvement of the digestive system, which can manifest as a range of gastrointestinal complaints. Among these, inflammation of the stomach lining, a condition referred to as gastritis, has been increasingly reported both during the acute phase of the infection and in the recovery period. Understanding this connection is important for managing the full scope of the illness. This stomach inflammation often contributes to a patient’s overall discomfort.
Recognizing Gastritis Symptoms During or After COVID
Gastritis symptoms associated with COVID-19 can be similar to other forms of stomach irritation. A persistent burning or gnawing ache in the upper abdomen, known as epigastric pain, is a common indicator of this inflammation. This discomfort may be accompanied by frequent feelings of nausea, which can occasionally lead to vomiting.
Patients often report a rapid feeling of fullness after starting to eat or a general loss of appetite. Bloating or a sense of pressure in the stomach area may also be present.
These symptoms may appear before the typical respiratory signs of COVID-19, or they may emerge weeks to months later as part of a prolonged recovery or post-viral syndrome. When these gastric symptoms persist beyond the initial infection, they are considered part of the long COVID presentation.
How SARS-CoV-2 Causes Stomach Inflammation
The direct mechanism by which SARS-CoV-2 affects the stomach involves binding to the angiotensin-converting enzyme 2 (ACE2) receptor, which is present in various tissues, including the cells lining the gastrointestinal tract. Stomach tissues specifically express ACE2, allowing the virus to directly infect and damage the protective mucosal layer.
Once the virus binds to ACE2, often with the help of the TMPRSS2 enzyme, it can replicate and cause direct injury to the gastric epithelial cells. This cellular damage compromises the integrity of the stomach lining, leading to the inflammation characteristic of gastritis. Beyond the direct viral attack, the body’s massive immune response also plays a significant role in causing damage.
The systemic inflammatory response, often described as a cytokine release, floods the body with signaling molecules that can inadvertently harm healthy tissues. This widespread inflammation contributes to the damage of the gastric mucosa. Furthermore, the virus can cause injury to the lining of blood vessels, potentially leading to microclots that restrict blood flow to the stomach wall. The combined effect of direct viral entry, the intense immune reaction, and vascular disruption creates an environment conducive to severe or chronic stomach inflammation.
Managing and Treating COVID-Associated Gastritis
Management of COVID-associated gastritis focuses on reducing stomach acid production to allow the inflamed lining to heal and mitigating discomfort. Medical professionals recommend acid-reducing medications, such as proton pump inhibitors (PPIs) or histamine-2 (H2) blockers, which decrease the amount of acid the stomach produces. Over-the-counter antacids may also provide temporary relief by neutralizing existing stomach acid after a meal.
Dietary Modifications
Simple dietary modifications are highly effective in reducing irritation to the damaged gastric lining. Patients should avoid known irritants, which typically include spicy foods, highly acidic items like citrus and tomatoes, and beverages such as coffee and alcohol. Eating smaller, more frequent meals instead of three large ones can also help prevent the stomach from becoming overly full, which reduces acid backflow and pressure.
Hydration is important, and bland, easily digestible foods should be prioritized to support the gut as it recovers. Incorporating varied, nutritious foods and potentially using probiotics can help restore the gut microbiome, which is often disrupted during a COVID-19 infection and its subsequent treatments.
When to Seek Medical Attention
Patients must seek immediate medical attention if they experience signs of severe complications, such as vomiting bright red blood, vomit resembling coffee grounds, or passing black, tarry, or bloody stools. Severe, sudden-onset abdominal pain or the inability to keep fluids down due to persistent vomiting also warrant prompt consultation with a healthcare provider.