Introduction

Exposure to COVID-19 has been shown previously associated with a higher risk for long-term gastrointestinal symptoms and disorders of gut-brain interaction (DGBI) occurrence, including irritable bowel syndrome (IBS) (1). However, it is still unclear whether SARS-CoV-2's effects on the gastrointestinal tract are more severe in patients already diagnosed with a DGBI and symptoms fluctuations in these patients over time after COVID-19 exposure.

Aims & Methods

To explore hospitalization outcomes and gastrointestinal (GI) symptoms fluctuation over a 1-year follow-up of COVID-19 patients with IBS or functional dyspepsia (FD) at enrollment compared to COVID-19 patients without any previous GI symptoms/disorders/diseases/surgeries.
In this retrospective multicenter cohort study, patient charts were reviewed for demographic data, medical history including GI chronic diseases, and hospitalization outcomes. All participants completed the Gastrointestinal Symptom Rating Scale (GSRS) over 4 time points: at COVID-19 onset, at 1, 6, and 12 months, and the Hospital Anxiety and Depression Scale (HADS) over 2 time points: at 6 and 12 months. The cohort was divided into two groups: (1) IBS/FD group (2) control group.

Results

A total of 599 patients were eligible for the study (n=61 IBS/FD group, n=538 control group). There were no differences between the groups regarding hospitalization outcomes. There was a significant decrease in both IBS/FD and control groups in depression [6.17±4.45 at 6 months and 3.17±4.14 at 12 months for IBS/FD group (p=0.007) and 3.55±4.02 at 6 months and 3.05±3.74 at 12 months for the control groups (p=0.019), respectively] and anxiety levels over time [5.94±4.32 at 6 months and 4.10±4.58 at 12 months for IBS/FD group (p=0.019) and 3.58±3.71 at 6 months and 3.26±3.65 at 12 months for the control groups (p<0.001), respectively]. The pooled Odds Ratios (OR) of the effect of IBS/FD over 4 time points ranged from 1.93 for diarrhea to 5.10 for increased distention, and were statistically significant for all GI symptoms, even after adjustments for gender, depression, and anxiety. While there was a significant improvement over time in the severity of abdominal pain (p=0.008), hunger pains (p=0.011), nausea (p=0.001), diarrhea (p=0.005) and loose stool (p=0.007), there was also a significant deterioration in constipation (p=0.002), hard stool (p<0.001) and feeling of incomplete evacuation (p=0.007) among the IBS/FD group.

Conclusion

Gastrointestinal symptoms within and between the control group and the IBS/FD group changed over time after COVID-19 onset. Patients with IBS or FD at enrollment showed increased complaints of constipation, hard stool, and incomplete evacuation after COVID-19 exposure.

References

1. Marasco G, Cremon C, Barbaro MR the GI-COVID19 study group, et al Post COVID-19 irritable bowel syndrome. Gut 2023;72:484-492.

Introduction

Among patients with functional gastrointestinal disorders (FGID), food intake is often identified as a symptom trigger. Common foods known to cause gastrointestinal (GI) symptoms include fatty foods (1) and fermentable carbohydrates (FODMAPs) (2), but the evidence is limited and may vary among different FGID.

Aims & Methods

The aim of this study was to explore if certain foods are considered more tolerable, and which specific foods are identified as triggers of GI symptoms among participants with irritable bowel syndrome (IBS) and functional dyspepsia (FD). An online survey was conducted including n=537 participants from the Swedish general population with symptoms compatible with a functional bowel disorder. The survey included questions on demographics and an adapted food frequency questionnaire that assessed intakes of 38 different food items or aggregated food groups. For each food, participants had to answer whether or not they considered the specific food to be a trigger for GI symptoms.

Results

Among the respondents, a total of 220 participants with IBS and/or FD (mean age 34.7 years, body mass index 26.8 kg/m², women: 78.2%) were included in the analyses, of whom n=128 fulfilled criteria for FD and n=136 for IBS. Foods that were least commonly reported to cause GI symptoms included hard bread, fish and shellfish, berries, nuts, and seeds (Figure). The most frequently reported food triggers included pizza, crisps, confectionery, candy, ice cream, white bread, dairy, french fries, pie, and sausages. White bread, more often than whole grain bread, was reported to cause GI symptoms. Most vegetables and fruits were well tolerated in FD. A few FODMAP-rich vegetables, such as onion, garlic, beans, lentils, cauliflower and cabbage were more often reported as food triggers in IBS compared with FD. Having overlapping IBS and FD increased the prevalence of foods that were considered to cause symptoms.

Conclusion

In individuals with IBS and/or FD, foods traditionally associated with a healthy dietary pattern were less commonly reported to cause GI symptoms, whereas foods associated with western food/junk food were more commonly reported to cause GI symptoms. Promoting healthy food choices seem compatible with dietary treatment of patients with IBS and FD.

References

1, Feinle-Bisset C, Azpiroz F. Dietary and lifestyle factors in functional dyspepsia. Nature reviews Gastroenterology & hepatology. 2013 Mar;10(3):150-7.
2. van Lanen AS, de Bree A, Greyling A. Efficacy of a low-FODMAP diet in adult irritable bowel syndrome: a systematic review and meta-analysis. European journal of nutrition. 2021 Sep;60:3505-22.

Introduction

Multiple recent studies suggest that COVID-19 (COVID) infection may increase risk of developing Disorders of Gut-Brain Interaction (DGBI). However, the extent of this effect on a population level, and how directly it is related to COVID illness, remains poorly understood.

Aims & Methods

We aimed to test in a multi-national sample the a priori hypotheses that IBS and FD prevalence rates (1) have increased after the COVID-19 pandemic, and are higher in individuals (2) who were more ill with their COVID infection, (3) who have long COVID, and (4) who were not vaccinated for COVID. A population-based Internet survey with pre-defined demographic quotas to obtain equivalent sex and age distribution across countries was conducted nationwide in 9 countries (Canada, China, Germany, Japan, Mexico, Poland, Romania, Spain, United States) in late 2023, and included demographic questions, Rome IV IBS and FD diagnostic questions, and questions about history of COVID infection and illness. Group prevalence was compared with Chi-Square tests to test the 4 hypotheses. For hypothesis 1, the total sample was compared to a pre-pandemic Rome Foundation Global Epidemiology Study (RFGES; Sperber et al. Gastroenterology 2021;160(1):99-114) sample from the same 9 countries, surveyed with comparable methodology in 2017-2018, using weighting to equalize country sample sizes.

Results

The survey was completed by 17,663 participants (50.2% females; mean age 46.3 years, range 18-96). People in the current sample had higher prevalence of both Rome IV IBS [% and 95% CI: 7.9% (7.5, 8.3) vs. 3.8% (3.5, 4.1); p<0.0001] and FD [12.7% (12.2, 13.2) vs. 7.0% (6.6, 7.4); p<0.0001] compared to the pre-COVID RFGES sample (N=19,669, 50.2% females, mean age 45.4 years, range 18-95) for the same countries. The post- vs. pre-pandemic prevalence of FD and IBS was numerically higher in all countries, and in all age and sex subgroups. In the current survey, people who reported having had test-confirmed COVID (41.3%) had higher IBS [9.4% (8.8, 10.1) vs. 6.8% (6.3, 7.2); p<0.0001] and FD [14.6% (13.8, 15.4) vs. 11.3% (10.7, 11.9); p<0.0001] prevalence than those without a COVID test-positive history. Those who were moderately or very ill during COVID infection had higher prevalence of IBS [12.0% (10.9, 13.0) vs. 6.8% (6.0, 7.7); p<0.0001] and FD [17.6% (16.4, 18.9) vs. 11.4% (10.4, 12.4); p<0.0001] compared to those with mild or no symptoms, and even higher if they had new-onset GI symptoms during their COVID illness (15.1% IBS, 21.3% FD). People with current lingering symptoms from past COVID infection (“long COVID”) had higher IBS [16.3% (14.4, 18.3) vs. 7.8% (7.1, 8.5); p<0.0001] and FD [22.9% (20.7, 25.1) vs. 12.6% (11.8, 13.5); p<0.0001] prevalence than fully recovered individuals. People who had not been vaccinated for COVID (19.4% of the sample) had higher prevalence of FD [14.3% (13.1, 15.4) vs. 12.3% (11.7, 12.8); p<0.0001] but not IBS [8.4% (7.4, 9.4) vs. 7.7% (7.3, 8.2); p=0.18] compared to the vaccinated.

Conclusion

Our findings indicate that both IBS and FD prevalence rates are significantly higher now among adults worldwide than before the COVID-19 pandemic. Greater illness severity during COVID infection and current long COVID status show striking associations with elevated prevalence of these DGBI. Although retrospective infection/illness self-report cannot prove causation, this pattern of findings strongly implicates COVID-related illness as a potent driver of subsequent vulnerability to having IBS and FD, leading to an increased population prevalence of these disorders.

Introduction

Psychiatric comorbidity, most commonly measured as severity of anxiety and depression symptoms, has been found to be associated with IBS symptom severity. However, available studies have rarely assessed the importance of formal psychiatric diagnoses on disease burden in IBS. In this analysis from a pan-European project (DISCOvERIE) focusing on the relevance of comorbid mental (anxiety, depression) and/or somatic (fibromyalgia, chronic fatigue syndrome) diagnoses in patients with IBS, we aimed to assess whether presence of psychiatric diagnoses according to the DSM-5 criteria has an impact on overall symptom severity in IBS.

Aims & Methods

We included patients with IBS according to the Rome IV criteria from nine different European centers. Exclusion criteria included the presence of severe psychiatric disease (i.e. bipolar disorder, schizophrenia, autism spectrum disorder, schizoaffective disorder, or organic psychiatric disorder demanding psychopharmacotherapy, psychiatric day-care or inpatient treatment). The patients underwent The Mini International Neuropsychiatric Interview (MINI) to diagnose major psychiatric diagnoses (a total of 17). Fibromyalgia and chronic fatigue were diagnosed by current diagnostic criteria. They also filled in questionnaires assessing Severity of IBS symptoms (IBS-SSS), depression (PHQ-9), anxiety (GAD-7), somatic symptoms (PHQ-15), and fibromyalgia symptoms (FIQ). Severity of symptoms were compared between groups with increasing number of psychiatric diagnoses using One-Way Between-Groups ANOVA with linear trend analysis.

Results

In total, 617 patients with IBS (median age 44 years, 80% females) were included. Among the IBS patients, 269 (44%) had none of the mental (anxiety, depression) or somatic (fibromyalgia, chronic fatigue syndrome) comorbidities (median age 44 y, 75% females), whereas 174 (28%) had comorbid mental disorder only (median age 38 y, 82% females), 49 (8%) had comorbid somatic disorder only (median age 50 y, 86% females) and 124 patients (20%) had mental and somatic comorbidities (median age 47 y, 86% females). The most common psychiatric diagnoses among the IBS patients were depression (n=284), generalized anxiety disorder (n=145) and panic disorder (n=38) followed by agoraphobia (n=23) and social anxiety (n=19). Participants were divided into four groups according to the number of psychiatric diagnoses (0, 1, 2, and ≥3). The severity of IBS, depression, anxiety, somatic, and fibromyalgia symptoms all increased gradually with increasing number of psychiatric diagnoses. The effect sizes (partial eta squared) were small for IBS symptoms, medium for somatic symptoms and large for the other severity measures (Table 1).

Table 1: Symptom severity in groups with increasing number of psychiatric diagnoses

Conclusion

This multicenter pan-European study shows that psychiatric diagnoses are common among IBS patients and that the overall disease burden in IBS is associated with psychiatric comorbidity. These findings highlight the importance of taking psychiatric comorbidity into consideration and to acknowledge the relevance of gut-brain axis interactions when managing patients with IBS.

Disclosure

Hans Törnblom: Consultant or advisory board member for Allergan, Cinclus Pharma, Medifactia, and VIPUN and as a speaker for Tillotts, Takeda, and Shire.
Daisy Jonkers: Part of the work of DJ, outside the submitted work has been financed by public-private partnership grants of Top Knowledge Institute (TKI) Agri&Food and Health Holland, by the Carbokinetics program as part of the NWO-CCC Partnership Program, by Organic A2BV/Mothersfinest BV.