Page 83 - JCBP-3-4

Journal of Clinical and
Basic Psychosomatics Psychological COVID-19 gastrointestinal

1. Introduction T cells, which can affect the small intestine through the
gut-lung axis, resulting in intestinal immune damage and
Since its emergence in 2019, severe acute respiratory syndrome- diarrhea. Reports indicate that COVID-19 patients with
coronavirus 2 (SARS-CoV-2) has rapidly spread from China GI symptoms tend to have longer viral detoxification time
across the globe, resulting in millions of hospitalizations and a higher potential for SARS-CoV-2 detection in fecal
and thousands of disabilities and deaths. Over 450 million samples. In addition, the majority of COVID-19 patients
1-3
12
cases of the COVID-19 pandemic were reported worldwide are treated with a combination of antiviral and antibacterial
in the first 2 years, including approximately 100 million medications, which frequently induce diarrhea as a side
cases in the European Union alone. Aerosolized respiratory effect. GI symptoms such as diarrhea in COVID-19 are
11
particles released when infected individuals cough, sneeze, linked to several mechanisms, such as gut microbiota
or speak in close proximity to others are the primary mode changes and pro-inflammatory cytokines release, either
of SARS-CoV-2 transmission. These infectious particles can due to the virus interaction with ACE2 receptors or as
be inhaled or come in contact with the eyes, nose, or mouth, adverse effects of pharmacological treatment. Recently,
13
leading to new infections. 4
two critical questions have emerged: First, whether the
During the COVID-19 pandemic, several studies have presence of GI symptoms worsens the overall prognosis
focused on the impact of the virus on the respiratory in COVID-19 patients; and second, whether the increased
system, largely due to the high prevalence and severity of prevalence of these symptoms is linked to emerging
symptoms such as cough, dyspnea, oxygen desaturation, variants of the virus. 1
and respiratory failure. These symptoms are responsible for Nutritional status plays a significant role in immunity at
the majority of the disease’s devastating and life-threatening various levels, including susceptibility to infection, severity
complications. However, clinicians and researchers rapidly of illness, and the duration of recovery and hospitalization.
recognized that the novel strains of SARS-CoV-2 do not In addition, COVID-19 may affect the digestive system,
exclusively target the respiratory system. On the contrary, further compromising nutritional status. Therefore, it
12
in most cases, multiple organ systems were involved. is advised that physicians managing COVID-19 patients
Apart from the lungs, organs such as the brain, heart, closely monitor GI symptoms, body weight, and overall
intestine, gallbladder, and liver have also been shown to be nutritional status. Moreover, the efforts to restrain the
14
susceptible to SARS-CoV-2 infection. 5
spread of the virus, such as social and physical distancing,
One of the frequently affected organs by SARS-CoV-2 in addition to the fear of infection, have significantly
is the gastrointestinal (GI) tract. GI diseases affect 5 – 20% disrupted daily life. These disruptions have contributed
of the general population. Their potential causes are often to widespread psychological disturbances, such as anxiety
6
multifactorial, including genetic predisposition, dietary and frustration, and may have led to more severe and
habits, gut–brain axis dysregulation, and stress. Irritable catastrophic psychological and psychiatric disorders in the
7
bowel syndrome and functional dyspepsia are classified general population. 15
among the most common GI diseases. Factors that can Psychopathology can be triggered by immune system
trigger these conditions include stress, negative life events, dysregulation resulting from viral infections, potentially
and anxiety. 8 leading to numerous psychiatric consequences. Respiratory
GI symptoms, such as abdominal pain, nausea, viral illnesses have been associated with both short-term
vomiting, anorexia, and diarrhea, have been reported in and long-term psychopathological impacts in survivors.
6
more than 20% of hospitalized COVID-19 patients. SARS- Coronaviruses, negatively stranded RNA viruses, are
9
CoV-2 primarily binds to angiotensin-converting enzyme known to cause illnesses ranging from the common
2 (ACE2) receptors to enter human cells, initially affecting cold to more severe conditions such as SARS. Evidence
the lungs and subsequently the GI tract. According to from previous coronavirus outbreaks, including Middle
research, a significant number of ACE2 receptors are East respiratory syndrome and SARS, has shown a clear
expressed in the GI system, particularly in the colon and association between coronavirus and the development
small bowel. This receptor distribution is potentially why of neuropsychiatric illnesses. Follow-up studies of SARS
diarrhea is the main GI symptom in COVID-19 patients. 10 survivors have reported increased incidence of mental
Damage to the intestinal mucosal barrier and alterations health diagnoses, such as panic disorder, obsessive–
in the host immune response, particularly inflammatory compulsive disorder, post-traumatic stress disorder
6
factor production, can contribute to developing GI (PTSD), and depression.
symptoms. Notably, infection of lung cells by SARS-CoV-2 The recent COVID-19 pandemic seems to have
11
activates effector cluster of differentiation-positive (CD4 ) significant psychiatric consequences. Preliminary data
+
Volume 3 Issue 4 (2025) 77 doi: 10.36922/JCBP025040007