Does COVID-19 Cause Intestinal Angina?

Based on an article titled “Bowel ischemia in COVID-19: A systematic review”

Original written by: Patel et al., 2021

https://onlinelibrary.wiley.com/doi/10.1111/ijcp.14930

By: Murielle Nsiela 

Intestinal angina is abdominal pain due to reduced blood flow to the intestines. This occurs as a result of a blockage in the superior mesenteric artery, found in the intestines, due to the build-up of fat or a blood clot. ; tThis issue can progress to sepsis or potentially death. It is said that people assigned female at birth (AFAB) are three times more likely to develop intestinal angina than people assigned male at birth (AMAB).¹ 

The disorder’s symptoms include having abdominal cramps approximately 30 minutes after a meal, with the pain lasting for one to three hours. In addition to this, unintentional weight loss or anorexia, bloating, nausea, and diarrhoea are common symptoms.² 

Several risk factors are associated with intestinal angina, including age: about 80-85% of individuals diagnosed with intestinal angina are aged 60 years and above. Furthermore, smoking statistics show that 75-80% of individuals diagnosed with abdominal angina are smokers.³ In addition, hypertension, heart failure and blood-clotting factors play a role in developing intestinal angina.² 

Furthermore, both type 1 and 2 diabetes, have been seen in patients diagnosed with the disorder; about 82% of individuals have diabetes upon diagnosis.¹ Despite these risk factors, there have been speculations about whether COVID-19 could potentially cause intestinal angina, as there have been reports of gastrointestinal complications in patients with COVID-19 in the past two years. Therefore, a study by Patel et al. carried out a systematic review to gain a better understanding of COVID-19 induced intestinal angina.⁴ 

COVID-19 (also known as SARS-CoV-2) is a type of virus that spreads through air droplets which can cause mild symptoms from loss of taste and smell, to severe symptoms such as respiratory distress syndrome.⁵ 

It has been suggested that the SARS-CoV-2 produces an environment in the body where blood clots are easily developed, leading to blood clots in the arteries and veins.⁶ As a result, this affects the cardiovascular, nervous, and gastrointestinal systems. Potential effects of blood clots caused by COVID-19 include intestinal angina and stroke.⁷ 

The study showed a strong relationship between the severity of COVID-19 and gastrointestinal symptoms. It was proved that 40% of coronavirus-positive patients had adverse gastrointestinal symptoms, and abdominal pain was linked to a 2.8 fold increased chance of developing severe COVID-19 symptoms.⁸  

As some COVID-19 patients are asymptomatic, it is easy to miss some of these cases; therefore, further investigations are required, such as conducting stool PCR.^9,10 With the growing number of studies on coronavirus, it was found that 48.5% of COVID-19 patients presented with symptoms of anorexia, diarrhoea, abdominal pain and vomiting.¹¹⁰ 

As this is an evolving topic, there are no specific management guidelines for COVID-19 related intestinal angina. However, some drugs can be administered to prevent the disease from occurring. In addition, screening with X-ray (CT) imaging of the abdomen can help early diagnosis of intestinal angina.¹¹² In addition, there are surgical options available for patients.⁴ 

In conclusion, intestinal angina is a complication of COVID-19, which requires early diagnosis for better outcomes. However, more studies are required for better management.