People With IBS See Silver Lining in Lockdown

The pandemic-related stay-at-home mandate may have been a good thing for patients with irritable bowel syndrome (IBS): improvement in IBS-severity symptoms, anxiety, and somatization, according to a survey-based study from Argentina.

There was a significant decrease in the proportion of patients with severe symptoms from 50.39 % to 30% (P=0.000) compared with their pre-pandemic state, reported Juan Pablo Stefanolo, MD, of the Hospital de Gastroenterologia Dr. Carlos Bonorino Udaondo in Buenos Aires.

Before the pandemic, the study cohort had a mean IBS Syndrome Severity Scale (IBS-SS) score of 278.54 versus 212.36 during lockdown, for a difference of -65.9 (95% CI –89.4 to – 42.4, P=0.000), he stated in a presentation at the Digestive Disease Week virtual meeting.

IBS is a multifactorial entity, in which socioemotional factors and social stress might play a central role in the generation and worsening of symptoms. The COVID-19 pandemic has been reported to worsen existing, or trigger new symptoms of IBS.

“The mandatory lockdown in response to the SARS CoV-2 pandemic, represents a unique scenario of reduced social interaction and complexity, potentially impacting the IBS patients’ symptoms evolution,” Stefanolo explained.

His group used telephone and online surveys in 129 patients in an existing database at at tertiary care center. Individuals had IBS-diarrhea or the mixed bowel-pattern subtype. The mean age of the Rome IV-defined cohort was 54, and 78% were female.

Other measures used were the Likert scale of improvement, the Bristol stool scale, and measures of anxiety, depression, and somatization. Further, patients were asked about comorbidities such as pyrosis and/or regurgitation, dyspepsia, chronic fatigue, fibromyalgia, non-migraine headache, weight, and eating habits.

The authors reported an average 1-point decrease on the Likert scale in global IBS symptoms, pain, and distension, and an improvement in stool consistency, with a 2-point average decrease on the Bristol scale.

Reduced exposure to external stressors during lockdown could have promoted better control of factors affecting the gut-brain axis in IBS, Stefanolo and colleagues suggested.

They found improvement in anxiety and somatization scores, and a significant decrease in fibromyalgia and chronic fatigue symptoms, during the lockdown versus the pre-pandemic period. On the debit side, however, headache and heartburn and/or regurgitation symptoms increased significantly.

The observed effects remained after adjustment for confounders such as age, sex, anxiety, and depression, indicating that the mandatory lockdown represented an independent protective factor for severe IBS symptoms (OR 0.39, 95% CI 0.18-0.87, P=0.02).

According to the researchers, the reduction in external stressors “could reduce the allostatic load and in turn diminish the atypical anticipatory interceptive inferences altered in the patients.”

William D. Chey, MD, of Michigan Medicine in Ann Arbor, said the study “highlights one of the potential silver linings of the pandemic and validates the importance of stress, diet, and lifestyle to the illness experience of IBS patients.”

Chey, who was not involved in the research, told MedPage Today that most studies to this point have focused on the shedding of virus into the stool of some infected patients and with subsequent reported GI symptoms, many of which are consistent with IBS, in a significant minority of patients with COVID-19.

“Stefanolo and colleagues present the other side of the coin. Their study, however, does not allow us to disentangle the respective roles of reduced stress, eating healthier meals, and improved sleep habits,” said Chey.

He said he has seen patients who developed new IBS symptoms during the pandemic, and patients who experienced a worsening of their pre-existing IBS symptoms, as well as patients who improved when they went into lockdown. “This teaches us that just as the pathogenesis and treatment of IBS is heterogeneous, so too is the clinical response to the pandemic and its consequences. When it comes to IBS, one size truly does not fit all.”