Gastrointestinal Impacts of SARS-CoV-2 Infection

The gastrointestinal tract is now recognised as a significant site of SARS-CoV-2 infection and pathogenesis. The angiotensin-converting enzyme 2 (ACE2) receptor, highly expressed on intestinal enterocytes, mediates viral entry and supports productive replication, leading to direct epithelial injury. Clinically, up to one in five patients experience symptoms such as diarrhoea, nausea and abdominal pain, and a substantial proportion shed viral RNA in faeces, sometimes persisting beyond respiratory clearance. Concurrently, infection disrupts the resident gut microbiome, depleting beneficial commensals and enriching opportunistic taxa, which may exacerbate inflammation, alter bile acid metabolism and compromise mucosal integrity. These combined effects contribute to disease severity, influence systemic immune responses and may underlie post-acute sequelae known as long COVID. Understanding gastrointestinal involvement offers opportunities for optimised diagnostics, infection control and targeted therapies, including modulation of the gut microbiota.

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Gastrointestinal Impacts of SARS-CoV-2 Infection publication trend

The graph below shows the total number of articles in gastrointestinal impacts of sars-cov-2 infection across all publications each year (not limited to Nature Index journals).

Technical terms

ACE2 receptor: A membrane enzyme highly expressed on intestinal epithelial cells that serves as the primary entry point for SARS-CoV-2.

Enterocyte: A specialised absorptive cell lining the small intestine that can be directly infected by SARS-CoV-2.

Gut microbiome: The collective community of bacteria, viruses and other microorganisms inhabiting the gastrointestinal tract, which influences immunity and metabolism.

Bile acid metabolism: The process by which bile acids are synthesised, modified by gut microbes and recycled, affecting fat digestion and host–microbe interactions.

Faecal viral shedding: The release of viral RNA or infectious particles in stool, indicating active or residual gastrointestinal infection.

References

1. Altered infective competence of the human gut microbiome in COVID-19. Microbiome (2023).
2. Metagenomic assessment of gut microbial communities and risk of severe COVID-19. Genome Medicine (2023).
3. SARS-CoV-2 productively infects human gut enterocytes. Science (2020).
4. TMPRSS2 and TMPRSS4 promote SARS-CoV-2 infection of human small intestinal enterocytes. Science Immunology (2020).
5. Prevalence of Gastrointestinal Symptoms and Fecal Viral Shedding in Patients With Coronavirus Disease 2019. JAMA Network Open (2020).
6. Infectious SARS-CoV-2 in Feces of Patient with Severe COVID-19 - Volume 26, Number 8—August 2020 - Emerging Infectious Diseases journal - CDC. Emerging Infectious Diseases (2020).