Severe IBS Symptoms Improved During COVID-19 Lockdowns

Andrew D. Bowser, MDedge News

May 27, 2021

Irritable bowel syndrome symptoms improved among patients who endured a prolonged COVID-19 lockdown in Argentina, a finding that was unexpected yet reaffirms the gut-brain connection in this gastrointestinal disorder, according to a coauthor of a study presented at the annual Digestive Disease Week® (DDW).

These patients with irritable bowel syndrome (IBS) reported improvements in disease severity and symptoms during the lockdown that were significant in comparison with the prepandemic period, according to Juan Pablo Stefanolo, MD, a lead author on the study.

The proportion of patients with severe IBS dropped from about 50% to 30%, accompanied by decreases in global and individual symptom scores, according to data presented at the meeting.

Investigators had assumed that IBS symptoms would worsen, fueled by new stresses and pressures related to a nationwide lockdown in Argentina that started in March 19, 2020, and didn't fully end until November.

Now, the hypothesis has changed, according to Stefanolo, a physician in the neurogastroenterology and motility section at Hospital de Clínicas José de San Martín, Buenos Aires University.

"We think that probably just staying at home in a more relaxed way, and in a more controlled environment, could have improved those symptoms," Stefanolo said in an interview.

Impact of Lifestyle Factors?

This reported decrease in overall severity and symptoms associated with IBS during the pandemic lockdown is an "interesting phenomenon" that deserves further study, said Purna C. Kashyap, MBBS, professor of medicine, physiology, and biomedical engineering at the Mayo Medical School, Rochester, Minn.

Diet, exercise, and other lifestyle factors such as spending more time with family could be contributing to the improvement in symptoms, said Kashyap, who was not involved in the study.

"A follow-up survey which includes these additional factors could help ascertain why there was an improvement in symptoms and could help with developing effective treatment strategies," Kashyap said.

A more detailed follow-up survey is definitely warranted, Stefanolo said, particularly as Argentina faces new and sweeping pandemic-related restrictions caused by a second-wave COVID-19 surge that now includes more than 30,000 new cases per day.

On May 21, Argentina entered a strict 9-day confinement period as President Alberto Fernández said the country was facing its "worst moment" of the pandemic to date.

Although the circumstances are very unfortunate, worsening pandemic conditions in Argentina are nonetheless a "perfect scenario" to explore in more detail how external stress burden impacts IBS symptoms, said Stefanolo.

Study Results

To study the impact of the 2020 mandatory lockdown on gut-brain axis symptomatology in IBS patients, Stefanolo and coauthors assessed a total of 129 patients with IBS-diarrhea or mixed bowel habits subtype. The mean age of participants was 54 years and 78% were female.

Patients were assessed by online survey or phone interview using the Irritable Bowel Syndrome Severity Scale (IBS-SS), Likert scales for IBS symptoms, and the Bristol Stool Scale, along with other measures of mood and comorbidities.

The proportion of patients with severe IBS dropped from 50% (65 patients) in the prepandemic period to 30% (39 patients) during the lockdown, Stefanolo and coauthors reported at the virtual DDW meeting. Similarly, mean IBS-SS scores dropped from 278.54 to 212.36 during lockdown, translating into a difference of 65.9 points.

Patients reported improvements in global IBS symptoms, pain, and distention. Stool consistency was also improved, with an average decrease on the Bristol scale of 2 points, according to the report.

Similar improvements from the prepandemic period were observed in anxiety and somatization scores, as well as in symptoms of fibromyalgia and chronic fatigue.

By contrast, headache and pyrosis and/or regurgitation symptoms increased from the prepandemic period, possibly because of weight gain, according to Stefanolo who said that about 60% of patients reported weight gain during the lockdown.

Lifestyle Advice

The patients in this study were being seen at a tertiary care center, so they tended to have more severe disease than what would be seen in general clinical practice, according to Stefanolo. Because of that, he advised caution in extrapolating these results to a broader patient population.

Nevertheless, this study does suggest the potential for lifestyle interventions that could make a difference for the average IBS patient, he said.

"It reinforces that outside stress has something to do with it, and that food maybe has something to do with it," he said. "I think that giving that advice – try to be more relaxed, and maybe control the quality or the type of food you have – could be great to improve ... those symptoms, maybe."

The study authors reported no financial disclosures related to the research. Kashyap reported relationships with Novome Biotechnologies, Otsuka Pharmaceuticals, and Pendulum.

Help your patients better understand IBS and symptoms by sharing AGA patient education at www.gastro.org/IBS.

This article originally appeared on GI & Hepatology News, the official newspaper of the AGA Institute.

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