COVID-19 is primarily known as a respiratory illness, often characterized by symptoms like a persistent cough, fever, and shortness of breath. However, the virus that causes the disease, SARS-CoV-2, is a multifaceted pathogen that affects various systems throughout the body. While the initial focus was on pulmonary symptoms, the clinical presentation of the illness can be far more varied than initially thought. This broader scope of symptoms includes issues unrelated to the lungs.
Identifying Gastrointestinal Symptoms of COVID-19
Stomach pain, or abdominal discomfort, is a recognized manifestation of COVID-19, though it is generally less common than respiratory complaints. Gastrointestinal (GI) symptoms often include nausea, vomiting, diarrhea, and loss of appetite. Abdominal pain is reported by approximately 2% to 15% of individuals diagnosed with the infection.
These digestive issues usually appear alongside typical symptoms like fatigue, body aches, or fever. GI symptoms can sometimes be the first sign of the illness, appearing before any respiratory problems. In rare instances, stomach pain may be the only symptom a person experiences during their acute infection.
How COVID-19 Affects the Digestive System
The ability of SARS-CoV-2 to cause stomach pain is rooted in its mechanism for entering human cells. The virus utilizes a specific protein receptor called Angiotensin-Converting Enzyme 2 (ACE2) to gain access into the body’s cells. This protein is highly expressed in the epithelial cells lining the gastrointestinal tract, especially within the small intestine.
When the virus binds to these receptors in the gut, it can directly infect and damage the intestinal lining, potentially leading to localized inflammation. This direct viral attack can cause enteritis or colitis, which manifests as cramping, discomfort, or abdominal pain. The resulting disruption to the gut barrier and the systemic inflammatory response further contribute to the pain and digestive upset.
Differentiating Stomach Pain Causes and Red Flags
Since stomach pain is a generic symptom, differentiating COVID-related discomfort from other causes like food poisoning or gastroenteritis can be challenging. COVID-19 abdominal pain is often accompanied by systemic signs, such as a loss of taste or smell, persistent headache, or muscle pain. In contrast, symptoms from food poisoning typically have a sudden onset and resolve within a day or two.
Gastroenteritis, commonly called the stomach flu, usually involves more pronounced vomiting and diarrhea but is rarely accompanied by the respiratory or neurological symptoms associated with the coronavirus. If the stomach pain is related to COVID-19, it may persist for a longer duration than a simple stomach bug, sometimes lasting for weeks.
Recognizing Urgent Symptoms
It is important to recognize specific “red flag” symptoms that signal a need for immediate medical attention, regardless of the suspected cause. These urgent warning signs warrant prompt medical evaluation:
- Severe, localized abdominal pain that does not subside (e.g., indicating appendicitis or pancreatitis).
- Inability to keep fluids down, leading to rapid dehydration.
- Evidence of gastrointestinal bleeding, such as bloody vomit or stool.
- Pain accompanied by confusion, a noticeably distended abdomen, or a high, spiking fever.