COVID-19 might be a trigger for new ulcerative colitis for some people. It may also be a trigger for symptom flare-ups for people previously diagnosed with UC.
COVID-19 is a respiratory illness caused by the virus SARS-CoV-2. It primarily causes respiratory symptoms, but it’s well-established that it can also affect other parts of your body, such as your gastrointestinal tract.
Research suggests that COVID-19 and other viral infections may contribute to the development of ulcerative colitis in some genetically prone people. Viral infections are also a common trigger for symptom flare-ups.
Let’s examine what’s known about the connection between COVID-19 and ulcerative colitis.
Ulcerative colitis is a type of inflammatory bowel disease (IBD) that occurs when the immune system attacks the lining of the large intestine. The course of the disease usually alternates between periods where symptoms flare up and periods where symptoms decrease.
The underlying cause of ulcerative colitis isn’t known, but some people are thought to be more genetically prone when exposed to certain environmental factors.
When you get a virus, your immune system triggers the release of molecules like cytokines that lead to inflammation throughout your body. Dysregulation of your immune system is a potential trigger of ulcerative colitis. In reverse, people with ulcerative colitis seem to be at higher risk of viral infections.
Additionally, COVID-19 and other viral infections cause psychological stress for some people, and stress is a known trigger for ulcerative colitis symptoms.
What research shows
Although many viral infections may trigger ulcerative colitis, it has also been specifically linked to COVID-19.
In a 2022 study, researchers reported two cases of IBD diagnosed shortly after recovery from COVID-19. In the first case, a 37-year-old male developed symptoms of ulcerative colitis 2 months after recovering from a COVID-19 infection that required a short course of steroids.
The second case was a 64-year-old male who developed a form of ulcerative colitis called proctosigmoiditis.
In another case report, researchers reported a 74-year-old male who developed new ulcerative colitis a month after having COVID-19.
In a 2024 review of studies, researchers examined the connection between ulcerative colitis and COVID-19 in a sample of 224,520 people from 19 studies. The researchers found that the overall risk of hospitalization in people with COVID-19 and ulcerative colitis was 28% higher than in the general population. The chances of getting severe COVID-19 were 30% higher.
Some people can experience ulcerative colitis flare-ups with confirmed COVID-19 infection. For example, in a 2022 study, researchers reported two cases of people who experienced mild and severe symptom flare-ups associated with COVID-19 infection.
In a 2024 study, researchers found statistically significant evidence of an association between COVID-19 and either ulcerative colitis or Crohn’s disease flare-ups. Crohn’s disease is another type of IBD.
Vaccines come with some risks. Evidence suggests that COVID-19 vaccines approved for use in the United States have a much smaller risk of complications than COVID-19 infection, but some serious side effects have been reported, such as:
- anaphylaxis (severe allergic reaction)
- myocarditis (heart inflammation)
- pericarditis (inflammation of tissue that surrounds the heart)
Receiving a COVID-19 vaccine can help prevent serious infection in people with ulcerative colitis, since they may be more likely to develop severe infection.
In rare cases, it’s plausible that vaccination could trigger ulcerative colitis by modulating immune activity. For example, researchers reported a suspected
However, the benefits of the vaccine far outweigh the risks in people with IBD, and those with IBD can have much more severe infections of COVID-19.
People with ulcerative colitis seem to be more susceptible to viral infections than people without ulcerative colitis. Ways you can help prevent COVID-19 infection include:
- receiving COVID-19 vaccination
- receiving vaccination for other infections that could weaken immune activity, such as influenza
- avoiding symptom triggers
- taking UC medications as prescribed
- washing your hands regularly and thoroughly with soapy water
- avoiding physical contact with sick people when possible
- avoiding areas where you might be susceptible to infection, such as public transport, when possible
- wearing a mask in areas where you have a high risk of COVID-19 infection
It’s important to speak with a doctor if you have potential symptoms of ulcerative colitis without a known cause, such as persistent and unexplained abdominal pain and diarrhea. You should also consult a healthcare professional if your symptoms are getting worse or you develop new symptoms.
The
- trouble breathing
- persistent chest pain or pressure
- new confusion
- trouble walking or staying awake
- pale, gray, or blue-colored skin, lips, or nail beds, which may be more difficult to spot on darker skin tones
COVID-19 and other viral infections appear to be a potential trigger for ulcerative colitis for some people. In reverse, having ulcerative colitis seems to make you more susceptible to viral infections.
COVID-19 vaccines also seem to trigger ulcerative colitis symptoms for a small number of people. However, the potential benefits of vaccination for people with ulcerative colitis outweigh the risks for most.
