De novo inflammatory bowel disease is a potential post-acute sequela of SARS-CoV-2 infection

Thanita Thongtan MD*, Anasua Deb MD*, Sameer Islam MD


Background: Even though patients with inflammatory bowel disease (IBD) are not at increased risk of COVID-19 infection, patients with post-acute COVID-19 have been reported to have de novo IBD or a new diagnosis of IBD.

Objective: This article reviews the presentation, diagnosis, and clinical course of patients described in the literature to have new-onset IBD after the diagnosis of COVID-19 infection and discusses the possible pathophysiological mechanism.

Methods: Extensive literature review by compiling information from case reports and original studies identified by a PubMed and EMBASE search from inception to May 2021.

Results: We identified 4 case reports de novo IBD that occurred 2 weeks to 5 months after acute COVID-19 infection. Patients presented with persistent bloody diarrhea, abdominal pain, and anemia. Three patients were diagnosed with ulcerative colitis, and one patient was diagnosed with Crohn’s disease. Available evidence suggests that COVID-19 infection can cause intestinal inflammation and trigger de novo IBD, potentially through intestinal barrier leakage, alterations in gene expression, gut microbiota dysbiosis, and an exaggerated immune response.

Conclusion: The presence of the SARS-CoV-2 virus in the gut can cause de novo IBD through complex multiple factors. Further studies need to be done to confirm a causal link and the underlying mechanism. Clinicians should be vigilant about the possibility of IBD in patients present with anemia, abdominal pain, or chronic bloody diarrhea after a short interval of COVID-19 infection which may warrant a referral to a gastroenterologist.

Keyword: de novo inflammatory bowel disease, COVID-19 infection, SARS-CoV-2 virus, pathophysiology

Article citation: Thongtan T, Deb A, Islam S. De novo inflammatory bowel disease is a potential post-acute sequela of SARS-CoV-2 infection The Southwest Respiratory and Critical Care Chronicles 2021;9(41):35–39
From: Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
Submitted: 7/18/2021
Accepted: 9/26/2021
Reviewer: Drew Payne DO
Conflicts of interest: none
This work is licensed under a Creative Commons
Attribution-ShareAlike 4.0 International License.

* Co-first author.