The symptom burden of Irritable Bowel Syndrome in tertiary care during the COVID‐19 pandemic

Abstract

Background The COVID‐19 pandemic caused unprecedented disruption to healthcare services worldwide with well‐documented detrimental effects on mental health. Patients with refractory disorders of gut‐brain interaction such as Irritable Bowel Syndrome (IBS) seen in tertiary care tend to exhibit higher levels of psychological comorbidity, but the impact of the pandemic on IBS symptom severity in tertiary care is unknown. Methods As part of routine clinical care, consecutive tertiary referrals with refractory IBS patients prospectively completed a series of baseline questionnaires including IBS symptom severity score (IBS‐SSS), non‐colonic symptom score, Hospital Anxiety and Depression (HAD), and Illness impact scores. The symptom severity questionnaire data were compared for consecutive patients seen in tertiary care 12 months before and after the onset of COVID‐19 pandemic restrictions. Key Results Of 190 consecutive tertiary referrals with IBS, those seen during the pandemic had greater IBS severity (IBS‐SSS: 352 vs. 318, p = 0.03), more severe extra‐intestinal symptoms (non‐colonic score: 269 vs. 225, p = 0.03), sleep difficulties ( p = 0.03), helplessness and loss of control ( p = 0.02), but similar HAD‐Anxiety ( p = 0.96) and HAD‐Depression ( p = 0.84) scores. During the pandemic, unmarried patients ( p = 0.03), and keyworkers ( p = 0.0038) had greater IBS severity. Conclusions and Inferences This study has shown for the first time that patients seen in tertiary care with refractory IBS during the COVID‐19 pandemic had a significantly higher symptom burden emphasizing the importance of gut‐brain axis in IBS. Furthermore, lack of support and perceived loss of control appear to be contributory factors.

Disorders of gut-brain interaction post-COVID-19: a literature review

“…278.5, p = 0.0038). Anxiety levels were similar in both tertiary refractory IBS groups (pre-pandemic and pandemic groups) with a clinically relevant HAD-A score ≥ 8 in most of cases, as well as depression levels, which were mostly high in both cohorts, but not significantly different (HAD-S ≥ 8) 22 .…”

“…Further, the "COVID-19" AND "FD" search retrieved 14 results and only seven articles fulfilled the inclusion criteria (five of those had been identified in the previous searches). In addition, based on the focus of each paper, we classified them into the following subjects: impact of COVID-19 pandemic on the burden of DGBI [14][15][16][17][18][19][20][21][22][23][24] ; DGBI as risk factor for GI manifestations in patients with COVID-19 25 ; gastrointestinal sequels post-COVID-19 26,27 ; and prevalence and risk factors for post-COVID-19 DGBI [28][29][30] . In addition, one relevant paper, including data from Latin America regarding the impact of the pandemic on DGBI, not retrieved in the search was added.…”

Burden of persistent symptoms in treated coeliac disease: cause, aftermath or merely association?

“…In the study by Vuolle et al , the prevalence of extraintestinal symptoms including arthralgia and fatigue which affected over a third of those that were symptomatic, while unlikely to be a direct consequence of CD, are well-known somatic extraintestinal features of IBS. 6 Indeed, overlapping IBS symptoms are common, affecting over one-third of patients with CD, 7 and CD exclusion as an ‘IBS mimic’, is therefore strongly recommended when making an IBS diagnosis. 8 …”

“…In Open access the study by Vuolle et al, the prevalence of extraintestinal symptoms including arthralgia and fatigue which affected over a third of those that were symptomatic, while unlikely to be a direct consequence of CD, are wellknown somatic extraintestinal features of IBS. 6 Indeed, overlapping IBS symptoms are common, affecting over one-third of patients with CD, 7 and CD exclusion as an 'IBS mimic', is therefore strongly recommended when making an IBS diagnosis. 8 Making an appropriate, 'positive' clinical diagnosis of a DGBI such as IBS or FD, in those that meet the symptombased criteria for these conditions with quiescent CD, may help alleviate the burden of suffering, validating the patient's symptoms, and most importantly allowing access to evidence-based targeted medical, dietary and gut-specific behavioural interventions.…”

“…After exclusion of active CD in the gastroenterology clinic, in the absence of alarm features, among the main differential diagnoses in those with persistent gastrointestinal symptoms such as those reported in the Vuolle et al study, would be a disorder of gut–brain axis (DGBI) such as irritable bowel syndrome (IBS) or functional dyspepsia. In the study by Vuolle et al , the prevalence of extraintestinal symptoms including arthralgia and fatigue which affected over a third of those that were symptomatic, while unlikely to be a direct consequence of CD, are well-known somatic extraintestinal features of IBS 6. Indeed, overlapping IBS symptoms are common, affecting over one-third of patients with CD,7 and CD exclusion as an ‘IBS mimic’, is therefore strongly recommended when making an IBS diagnosis 8…”