Salman A. Post-acute COVID-19 gastrointestinal sequelae: Mechanisms of persistent dysbiosis, intestinal barrier dysfunction, and emerging long-COVID phenotypes. World J Clin Infect Dis 2026; 15(1): 124175 [DOI: 10.5495/wjcid.124175]
Corresponding Author of This Article
Ahmed Salman, FRACP, FRCP, MRCP, Department of Internal Medicine, Kasr Alainy School of Medicine, 1 Al-Saray Street, Al-Manial, Cairo 11562, Egypt. awea844@gmail.com
Research Domain of This Article
Infectious Diseases
Article-Type of This Article
review-article
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Infect Dis. Sep 8, 2026; 15(1): 124175 Published online Sep 8, 2026. doi: 10.5495/wjcid.124175
Post-acute COVID-19 gastrointestinal sequelae: Mechanisms of persistent dysbiosis, intestinal barrier dysfunction, and emerging long-COVID phenotypes
Ahmed Salman
Ahmed Salman, Department of Internal Medicine, Kasr Alainy School of Medicine, Cairo 11562, Egypt
Author contributions: Salman A contributed to the study conception, manuscript drafting, critical revision, and final approval of the manuscript.
AI contribution statement: Claude (Anthropic) was used in a limited manner solely for language refinement, including grammar, clarity, and readability. All scientific content, interpretations, and conclusions were independently reviewed and verified by the authors, who take full responsibility for the integrity and accuracy of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Ahmed Salman, FRACP, FRCP, MRCP, Department of Internal Medicine, Kasr Alainy School of Medicine, 1 Al-Saray Street, Al-Manial, Cairo 11562, Egypt. awea844@gmail.com
Received: June 9, 2026 Revised: July 1, 2026 Accepted: July 14, 2026 Published online: September 8, 2026 Processing time: 91 Days and 5.3 Hours
Core Tip
Core Tip: Long-coronavirus disease gastrointestinal manifestations affect 10%-30% of survivors, but remain overlooked. Persistent dysbiosis-the loss of beneficial bacteria and pathogenic enrichment-drives symptoms through barrier dysfunction, immune dysregulation, and endotoxemia. Dysbiosis has been implicated as a potential contributor to short-chain fatty acid depletion and impaired tryptophan metabolism; however, current human evidence is largely observational, and causality remains unproven. Clinical biomarkers (zonulin, I-FABP, and dysbiotic signatures) enable patient stratification. Microbiota-targeted interventions (probiotics, synbiotics, fecal microbiota transplantation, and postbiotics) offer rational therapeutic approaches. This review establishes dysbiosis as a central therapeutic target and provides an evidence-based framework for its clinical management.
