“ Functional gastrointestinal disorders (FGIDs) are known to be stress-sensitive disorders, with functional dyspepsia (FD) and [IBS] being two of the most common FGIDs,” according to a research team led by Tadayuki Oshima, MD, Ph.D. “Negative life events, stress, and anxiety are known to trigger and exacerbate FD and IBS. With the arrival of the COVID-19 pandemic, concerns rose that physical distancing was likely to take a toll on the mental health of these patients, as previous research has shown that physical distancing is leading to increased anxiety and depression. People are also fearful they will experience negative health and occupational effects due to the pandemic. To date, however, no published literature has been available on how FD and IBS patients have coped during the COVID-19 pandemic.”

For a study published in the Journal of Gastroenterology and Hepatology, Dr. Oshima and colleagues investigated the impact of the COVID-19 pandemic on the gastrointestinal and psychological symptoms of FD and IBS. The researchers conducted an online survey for a group of randomly assigned panelists from May 26-27, 2020. Each respondent answered a questionnaire on stress, physical distancing, and worries about COVID-19. Gastrointestinal symptoms were assessed to diagnose FD and IBS (Rome III), and psychological symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). A total of 5,157 patients were enrolled in the study.

Anxiety & Depression Scores Higher Due to Pandemic

The study team reported that for both gastrointestinal and psychological symptoms, respondents with FD–IBS overlap showed the worst scores, followed by those with IBS alone and then those with FD alone. “We found that the prevalence of FD–IBS overlap in FD or IBS was consistent with results from previous studies,” the authors noted. “Previously, the severity of gastrointestinal symptoms, but not age or sex, was reported to be more related to FD–IBS overlap than to FD or IBS alone. Psychological factors correlated significantly with quality of life in overlap syndrome of FGIDs. However, the anxiety and depression scores for all respondents in the present study were higher due to the pandemic than those under normal conditions.”

During the COVID-19 pandemic, 11.9% of respondents reported deterioration and 2.8% reported improvement of gastrointestinal symptoms. FD–IBS overlap, psychological disease comorbidity, and stress at work/school were significantly associated with symptom deterioration. The prevalence of IBS (16.6%) was greater than that of FD (8.5%), and the 4.0% of subjects with FD–IBS overlap comprised 46.6% of subjects with FD and 23.9% of those with IBS (Figure). The researchers also found that the prevalence of FD and/or IBS was greater in women than in men and decreased with age.

Be Mindful of Patients With FD & IBS Post-COVID

In addition, patients with FD and IBS symptoms experienced greater psychological stress under the COVID-19 pandemic, the researchers note. Mean anxiety and depression scores by HADS were 6.3 and 8.1, respectively, in all respondents living under the state of emergency, the study authors reported. The FD-only and IBS-only groups showed significantly higher anxiety (7.9 and 7.5, respectively) and depression (7.5 and 8.7, respectively) scores compared with the non-FD or IBS groups (5.9 and 7.6, respectively). Mean scores for anxiety (10.2) and depression (10.3) by HADS in the FD–IBS overlap group were significantly higher compared with those in the non-FD or IBS, FD-only, and IBSonly groups.

“Our findings reveal that more than 20% of respondents with FD or IBS experienced deterioration and a smaller number improved during the COVID-19 pandemic, although most showed no change in symptoms,” Dr. Oshima and colleagues wrote. “Respondents with FD–IBS overlap syndrome generally experienced the worst gastrointestinal and psychological outcomes. Interestingly, we found that the key factors determining improvement and deterioration during the COVID-19 pandemic involved both psychological disease comorbidity and occupational issues. Finally, we recommend that physicians be extra mindful of patients with FD–IBS during the post-COVID period.”