S2098 Persistent Gastrointestinal Symptoms Following SARS-CoV-2 Infection: A Systematic Review of Post-Acute Sequelae

Introduction: A group of patients recovering from a recent coronavirus disease 2019 (COVID-19) infection experience ongoing symptoms, which are called long COVID or post-acute COVID syndrome. Along with fatigue and breathing problems, people with long-term COVID-19 often develop gastrointestinal (GI) problems. Examples are frequent diarrhea, continual abdominal pain, nausea, dyspepsia, loss of appetite, and a change in bowel habits lasting over several months after SARS-CoV-2 infection. The reasons behind the illness might be persistent viral antigens, an imbalanced post-COVID microbiome, and immune system damage. Methods: We reviewed studies that detailed GI problems that lasted after COVID-19. From 2020 to 2025, the PubMed, Google Scholar, Web of Science, Cochrane Library, and Embase databases were consulted for studies that followed patients for at least 4 weeks after a COVID-19 diagnosis, reviewing their GI health. Information on GI issues for COVID survivors and controls, including their frequency and duration, was collected. The study showed moderate quality. Pooled long-COVID GI symptom rates were estimated with a random-effects meta-analysis. Results: Nineteen studies covering over 10,000 COVID-19 cases were analyzed. GI symptoms were reported in about 22% of long COVID patients (95% confidence interval [CI]: 10–41%), with 12% experiencing GI issues during acute infection, suggesting some developed new or persistent symptoms. Common long COVID GI complaints included appetite loss and functional dyspepsia (20% each), loss of taste (17%), abdominal pain (14%), diarrhea (10%), and nausea (6%). Many met criteria for post-infectious irritable bowel syndrome (IBS). Stool analyses revealed post-COVID gut dysbiosis, with reduced beneficial bacteria and lingering viral proteins in some patients. Heterogeneity was high (I² > 95%). Few post-viral syndromes have shown such widespread GI involvement. Conclusion: About 20% of long COVID patients experience persistent GI symptoms, commonly including appetite loss, digestive issues, and IBS-like complaints, highlighting the need for GI evaluation in post-COVID care. New chronic GI symptoms after SARS-CoV-2 infection warrant assessment for causes such as post-infectious IBS or bile acid malabsorption. While many symptoms resolve without treatment, dietary changes, probiotics, and bile acid binders may help. Ongoing research and long-term monitoring of COVID-19 survivors are essential to guide effective management of these GI complications.