University of North Carolina School of Medicine, Department of Medicine, Division of General Medicine and Clinical Epidemiology, 5034 Old Clinic Building, 101 Manning Drive, Chapel Hill, NC 27599, United States of America.
Life Sci. 2024 Nov 15;357:123100. doi: 10.1016/j.lfs.2024.123100. Epub 2024 Sep 30.
Long COVID is estimated to have affected 6.9 % of US adults, 17.8 million people in the US alone, as of early 2023. While SARS-CoV-2 is primarily considered a respiratory virus, gastrointestinal (GI) symptoms are also frequent in patients with coronavirus disease 2019 (COVID-19) and in patients with Long COVID. The risk of developing GI symptoms is increased with increasing severity of COVID-19, the presence of GI symptoms in the acute infection, and psychological distress both before and after COVID-19. Persistence of the virus in the GI tract, ensuing inflammation, and alteration of the microbiome are all likely mediators of the effects of SARS Co-V-2 virus on the gut. These factors may all increase intestinal permeability and systemic inflammation. GI inflammation and dysbiosis can change the absorption and metabolism of tryptophan, an important neurotransmitter. Long COVID GI symptoms resemble a Disorder of Gut Brain Interaction (DGBI) such as post infection Irritable Bowel Syndrome (IBS). Current standards of treatment for IBS can guide our treatment of Long COVID patients. Dysautonomia, a frequent Long COVID condition affecting the autonomic nervous system, can also affect the GI tract, and must be considered in Long COVID patients with GI symptoms. Long COVID symptoms fall within the broader category of Infection Associated Chronic Conditions (IACCs). Research into the GI symptoms of Long COVID may further our understanding of other post infection chronic GI conditions, and elucidate the roles of therapeutic options including antivirals, probiotics, neuromodulators, and treatments of dysautonomia.
据估计,截至 2023 年初,长新冠影响了美国 6.9%的成年人,仅美国就有 1780 万人。虽然 SARS-CoV-2 主要被认为是一种呼吸道病毒,但在 COVID-19 患者和长新冠患者中,胃肠道 (GI) 症状也很常见。随着 COVID-19 严重程度的增加、急性感染时出现 GI 症状以及 COVID-19 前后的心理困扰,出现 GI 症状的风险会增加。病毒在胃肠道内持续存在、随之而来的炎症以及微生物组的改变,都是 SARS-CoV-2 病毒对肠道影响的可能介导因素。这些因素都可能增加肠道通透性和全身炎症。GI 炎症和菌群失调会改变色氨酸的吸收和代谢,色氨酸是一种重要的神经递质。长新冠的 GI 症状类似于肠脑相互作用障碍(DGBI),例如感染后肠易激综合征(IBS)。目前 IBS 的治疗标准可以指导我们对长新冠患者的治疗。自主神经功能紊乱是一种常见的影响自主神经系统的长新冠病症,也会影响胃肠道,因此必须考虑到有 GI 症状的长新冠患者。长新冠症状属于感染后慢性疾病(IACC)的广义范畴。对长新冠 GI 症状的研究可以进一步了解其他感染后慢性胃肠道疾病,并阐明包括抗病毒药物、益生菌、神经调节剂和自主神经功能紊乱治疗在内的治疗选择的作用。
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