Chronic Nausea Since 2021 After COVID

Hi everyone, I’m a 21 year old male and have been dealing with chronic nausea and lower abdominal discomfort since 2021, after I had COVID-19. Before that, I was completely healthy.

This all began with severe nausea and abdominal pain a few months after the infection, I ended up in the ER and was given fentanyl and morphine to manage the pain. That acute pain eventually passed, but what remained is this constant, daily nausea and queasiness that has never gone away.

I used to rely on Zofran and Tylenol daily just to function. Things improved when I was prescribed amitriptyline 30mg, which made a significant difference. Without it, I’m much worse. But even with the medication, the nausea is still a daily struggle that affects my ability to eat, focus, and live normally. I still wake up in the mornings with what I'd describe as stomach discomfort/pain/burning? or hunger, its hard to explain. It's very positional, laying on my side seems to make my nausea worse so I usually sit up when I sleep, and in cars the nausea is the worst.

I’ve been apart of:

My province’s long COVID clinic, and
A gastroenterologist, who believed COVID damaged my brain-gut connection, possibly through vagus nerve dysfunction or autonomic disruption.

At first I tried to live with it. But as I’ve started working more and trying to be social again, it’s become debilitating. I just want to feel like myself again.

Tests I’ve Had:
MR Enterography (2022):
Mild bowel wall thickening and mucosal hyperenhancement in a 7 cm segment of the terminal ileum. Mild fat stranding and borderline ileocolic lymph nodes. Impression: “Could reflect Crohn’s disease; confirm endoscopically.”

CT Abdomen & Pelvis with Contrast (Oct 2021):
Mild right lower quadrant lymph node enlargement. No clear bowel inflammation. Follow-up MR enterography recommended.

Abdominal X-ray (2021):
Non-obstructive gas pattern, no diagnostic findings.

Gastric Emptying Study (2022):
Normal — rules out gastroparesis.

Bloodwork (2022):
Rheumatoid Factor < 11, CRP and immunoglobulins normal.

Full autoimmune panel:
CRP, ESR, ANA, ENA, ANCA, RF, IgG/IgA/IgM subclasses, all normal.

Nutritional & organ function labs:
Normal iron, ferritin, vitamin levels, liver enzymes, creatinine, CK, cortisol, BNP, etc.

Pulmonary function test & 6-minute walk (2022):
Part of long COVID clinic workup, no issues

My Questions:
Could the terminal ileum inflammation from 2 years ago still be relevant today?

Is it possible this is still post-COVID vagus nerve dysfunction or autonomic GI damage, even with normal motility tests?

Has anyone experienced Crohn’s-like inflammation without classic Crohn’s symptoms like diarrhea or blood?

This has been going on for years, and it’s really taken a toll. I just want to fix this and get my life back.