Early symptoms preceding post-infectious irritable bowel syndrome following COVID-19: a retrospective observational study incorporating daily gastrointestinal symptoms

Abstract

Background Intestinal microinflammation with immune dysfunction due to severe acute respiratory syndrome coronavirus 2 reportedly precipitates post-infectious irritable bowel syndrome. This study aimed to elucidate potential risk factors for subsequent development of irritable bowel syndrome, hypothesizing that it is associated with specific symptoms or patient backgrounds. Methods This single-center retrospective observational study (2020–2021) included adults with confirmed coronavirus disease requiring hospital admission and was conducted using real-world data retrieved from a hospital information system. Patient characteristics and detailed gastrointestinal symptoms were obtained and compared between patients with and without coronavirus disease-induced irritable bowel syndrome. Multivariate logistic models were used to validate the risk of developing irritable bowel syndrome. Moreover, daily gastrointestinal symptoms during hospitalization were examined in patients with irritable bowel syndrome. Results Among the 571 eligible patients, 12 (2.1%) were diagnosed with irritable bowel syndrome following coronavirus disease. While nausea and diarrhea during hospitalization, elevated white blood cell count on admission, and intensive care unit admission were associated with the development of irritable bowel syndrome, nausea and diarrhea were identified as risk factors for its development following coronavirus disease, as revealed by the adjusted analyses (odds ratio, 4.00 [1.01–15.84] and 5.64 [1.21–26.31], respectively). Half of the patients with irritable bowel syndrome had both diarrhea and constipation until discharge, and constipation was frequently followed by diarrhea. Conclusions While irritable bowel syndrome was rarely diagnosed following coronavirus disease, nausea and diarrhea during hospitalization precede the early signs of irritable bowel syndrome following coronavirus disease.

A Systematic Review of the Prevalence of Persistent Gastrointestinal Symptoms and Incidence of New Gastrointestinal Illness after Acute SARS-CoV-2 Infection

“…The studies were conducted from early 2020 to mid-2023 in twenty-eight different countries across Europe, the Americas, Africa and Asia ( Table 2 and Table 3 ). Forty-one studies were sourced from peer-review journals [ 8 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 ]. Four studies were pre-print and were awaiting peer review at the time of writing [ 70 , 71 , 72 , 73 ].…”

“…Studies varied in how they defined COVID-19 cases. Twenty-eight studies included only participants with a positive reverse transcription polymerase chain reaction test (RT-PCR) for SARS-CoV-2 [ 32 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 57 , 58 , 60 , 61 , 62 , 65 , 67 , 68 , 69 , 71 , 72 , 73 ]. Seven studies included participants who tested positive via an unspecified diagnostic method [ 30 , 33 , 56 , 59 , 64 , 66 , 70 ].…”

“…The studies also varied in their clinical settings and ascertainment of gastrointestinal symptoms. Fourteen studies were conducted on patients who were hospitalised with COVID-19, discharged and followed up in the community [ 33 , 34 , 35 , 41 , 42 , 43 , 44 , 45 , 57 , 60 , 62 , 63 , 67 , 71 ], twenty-one studies involved both hospitalised and community-managed cases [ 8 , 30 , 32 , 36 , 37 , 40 , 46 , 47 , 48 , 49 , 50 , 55 , 59 , 61 , 64 , 65 , 66 , 68 , 69 , 70 , 72 ], seven studies involved community cases that did not require hospital admission [ 38 , 39 , 51 , 52 , 53 , 56 , 58 ] and three studies did not specify the setting of recruitment [ 31 , 54 , 73 ].…”

“…Most studies ( n = 27) measured gastrointestinal outcomes using a survey or questionnaire administered via telephone or electronically [ 30 , 31 , 32 , 36 , 37 , 38 , 39 , 40 , 45 , 46 , 47 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 61 , 63 , 65 , 70 , 71 ]. Seven studies used EHRs to identify gastrointestinal endpoints based on clinical codes [ 8 , 60 , 66 , 67 , 69 , 72 , 73 ]. Eight studies involved an in-person clinical assessment by a healthcare professional [ 33 , 34 , 35 , 41 , 43 , 44 , 64 , 68 ].…”

“…Austhof et al reported the incidence of post-infection IBS to be 20.4% in a smaller study of 49 participants who completed a survey at six months, with half of these meeting the Rome IV diagnostic criteria for IBS [ 54 ]. In another study, multivariate logistic regression identified the presence of nausea and diarrhoea during acute SARS-CoV-2 infection as predictors for the development of IBS (OR 4.00 95% CI: 1.01–15.84 and OR 5.64 95% CI: 1.21–26.31, respectively) [ 67 ].…”