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The pathophysiological mechanisms linking this persistence to post-COVID IBS likely involve: Sustained inflammatory responses with elevated interferon levels Expansion of activated immune cells even 8 months post-infection Intestinal dysbiosis affecting the gut-brain axis Increased intestinal permeability during and after infection These findings suggest that long-term GI symptoms after COVID-19 may stem from ongoing intestinal inflammation driven by viral persistence, rather than merely representing psychological sequelae of the acute illness

doi:10.1007/s11626-012-9543-7

Furthermore, a key limitation of oral administration is the off-target effect, where most of the drugs may act on peripheral organs before they can reach the CNS

Semin Vasc Med 5 : 163171 Homocysteine Studies Collaboration 2002 Homocysteine and risk of ischemic heart disease and stroke: a meta-analysis

Reference lists of included articles and relevant reviews were manually screened to identify additional pertinent studies