Intestinal inflammation is a hidden pathology in COVID-19

Early in the pandemic there were a few scientific observations that were puzzling at the time. One was the early and persistent elevation of serum IgA titres in severe COVID-19, in some cases even higher than IgM (usually the first immune response).

The presumption was because of upper airway inflammation, however on reflection, although the nasal airways are infected, there is limited inflammatory changes in these regions. The other option is related to lower airways inflammation but once the virus is cleared within 7 to 10 days, this should also resolve.

Intestinal infection was presumed because of the presence of ACE-2 receptors in this region. In reality, the intestines represent the largest collection of ACE-2 receptors because the surface area is approximately the size of a tennis court.

This is further evidenced by recent research indicating that prolonged faecal shedding from the intestine can occur for up to 210 days.

Natarajan, Aravind, et al. "Gastrointestinal symptoms and fecal shedding of SARS-CoV-2 RNA suggest prolonged gastrointestinal infection." Med (2022).

The recent presentation from Dr Leo Galland (USA) at our Long Covid Coalition Conference, also highlighted gut microbiome changes that occur along severe COVID-19 with depletion of certain protective bacteria in the intestine.

Read his presentation pdf here >

Watch his YouTube presentation here >

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