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Published in: BMC Gastroenterology 1/2023

Open Access 01-12-2023 | Nausea | Research

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

Authors: Ryo Yamamoto, Asako Yamamoto, Tatsuhiro Masaoka, Koichiro Homma, Tadashi Matsuoka, Ryo Takemura, Michihiko Wada, Junichi Sasaki, Keio Donner Project

Published in: BMC Gastroenterology | Issue 1/2023

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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.
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Literature
1.
go back to reference Bhatraju PK, Ghassemieh BJ, Nichols M, Kim R, Jerome KR, Nalla AK, et al. Covid-19 in critically ill patients in the Seattle region — case series. N Engl J Med. 2020;382:2012–22.CrossRefPubMed Bhatraju PK, Ghassemieh BJ, Nichols M, Kim R, Jerome KR, Nalla AK, et al. Covid-19 in critically ill patients in the Seattle region — case series. N Engl J Med. 2020;382:2012–22.CrossRefPubMed
2.
go back to reference Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. 2020;323:2052–9.CrossRefPubMedPubMedCentral Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. 2020;323:2052–9.CrossRefPubMedPubMedCentral
3.
go back to reference Abani O, Abbas A, Abbas F. Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY Collaborative Group): A randomised, controlled, open-label, platform trial. Lancet. 2021;397:1637–45.CrossRef Abani O, Abbas A, Abbas F. Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY Collaborative Group): A randomised, controlled, open-label, platform trial. Lancet. 2021;397:1637–45.CrossRef
4.
go back to reference Beigel JH, Tomashek KM, Dodd LE, Mehta AK, Zingman BS, Kalil AC, et al. Remdesivir for the treatment of Covid-19—Final Report. N Engl J Med. 2020;383:1813–26.CrossRefPubMed Beigel JH, Tomashek KM, Dodd LE, Mehta AK, Zingman BS, Kalil AC, et al. Remdesivir for the treatment of Covid-19—Final Report. N Engl J Med. 2020;383:1813–26.CrossRefPubMed
5.
go back to reference Tomazini BM, Maia IS, Cavalcanti AB, Berwanger O, Rosa RG, Veiga VC, et al. Effect of dexamethasone on days alive and ventilator-free in patients with moderate or severe acute respiratory distress syndrome and COVID-19: the CoDEX Randomized Clinical Trial. JAMA. 2020;324:1307–16.CrossRefPubMed Tomazini BM, Maia IS, Cavalcanti AB, Berwanger O, Rosa RG, Veiga VC, et al. Effect of dexamethasone on days alive and ventilator-free in patients with moderate or severe acute respiratory distress syndrome and COVID-19: the CoDEX Randomized Clinical Trial. JAMA. 2020;324:1307–16.CrossRefPubMed
6.
go back to reference Sykes DL, Holdsworth L, Jawad N, Gunasekera P, Morice AH, Crooks MG. Post-COVID-19 symptom burden: what is long-COVID and how should we manage it? Lung. 2021;199:113–9.CrossRefPubMedPubMedCentral Sykes DL, Holdsworth L, Jawad N, Gunasekera P, Morice AH, Crooks MG. Post-COVID-19 symptom burden: what is long-COVID and how should we manage it? Lung. 2021;199:113–9.CrossRefPubMedPubMedCentral
7.
go back to reference Carfì A, Bernabei R, Landi F, Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent symptoms in patients after acute COVID-19. JAMA. 2020;324:603–5.CrossRefPubMedPubMedCentral Carfì A, Bernabei R, Landi F, Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent symptoms in patients after acute COVID-19. JAMA. 2020;324:603–5.CrossRefPubMedPubMedCentral
8.
9.
go back to reference Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan. China Lancet. 2020;395:497–506.CrossRefPubMed Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan. China Lancet. 2020;395:497–506.CrossRefPubMed
10.
go back to reference Blackett JW, Li J, Jodorkovsky D, Freedberg DE. Prevalence and risk factors for gastrointestinal symptoms after recovery from COVID-19. Neurogastroenterol Motil. 2022;34:e14251.CrossRefPubMed Blackett JW, Li J, Jodorkovsky D, Freedberg DE. Prevalence and risk factors for gastrointestinal symptoms after recovery from COVID-19. Neurogastroenterol Motil. 2022;34:e14251.CrossRefPubMed
11.
go back to reference Ghoshal UC, Ghoshal U, Mathur A, Singh RK, Nath A, Garg A, et al. The spectrum of gastrointestinal symptoms in patients with coronavirus Disease-19: predictors, relationship with disease severity, and outcome. Clin Transl Gastroenterol. 2020;11:e00259.CrossRefPubMedPubMedCentral Ghoshal UC, Ghoshal U, Mathur A, Singh RK, Nath A, Garg A, et al. The spectrum of gastrointestinal symptoms in patients with coronavirus Disease-19: predictors, relationship with disease severity, and outcome. Clin Transl Gastroenterol. 2020;11:e00259.CrossRefPubMedPubMedCentral
12.
13.
go back to reference Barbara G, Grover M, Bercik P, Corsetti M, Ghoshal UC, Ohman L, et al. Rome foundation working team report on post-infection irritable bowel syndrome. Gastroenterology. 2019;156:46-58.e7.CrossRefPubMed Barbara G, Grover M, Bercik P, Corsetti M, Ghoshal UC, Ohman L, et al. Rome foundation working team report on post-infection irritable bowel syndrome. Gastroenterology. 2019;156:46-58.e7.CrossRefPubMed
14.
go back to reference Zanini B, Ricci C, Bandera F, Caselani F, Magni A, Laronga AM, et al. Incidence of post-infectious irritable bowel syndrome and functional intestinal disorders following a water-borne viral gastroenteritis outbreak. Am J Gastroenterol. 2012;107:891–9.CrossRefPubMed Zanini B, Ricci C, Bandera F, Caselani F, Magni A, Laronga AM, et al. Incidence of post-infectious irritable bowel syndrome and functional intestinal disorders following a water-borne viral gastroenteritis outbreak. Am J Gastroenterol. 2012;107:891–9.CrossRefPubMed
15.
go back to reference Ghoshal UC, Ghoshal U, Rahman MM, Mathur A, Rai S, Akhter M, et al. Post-infection functional gastrointestinal disorders following coronavirus disease-19: A case-control study. J Gastroenterol Hepatol. 2022;37:489–98.CrossRefPubMed Ghoshal UC, Ghoshal U, Rahman MM, Mathur A, Rai S, Akhter M, et al. Post-infection functional gastrointestinal disorders following coronavirus disease-19: A case-control study. J Gastroenterol Hepatol. 2022;37:489–98.CrossRefPubMed
16.
go back to reference Settanni CR, Ianiro G, Ponziani FR, Bibbò S, Segal JP, Cammarota G, et al. COVID-19 as a trigger of irritable bowel syndrome: a review of potential mechanisms. World J Gastroenterol. 2021;27:7433–45.CrossRefPubMedPubMedCentral Settanni CR, Ianiro G, Ponziani FR, Bibbò S, Segal JP, Cammarota G, et al. COVID-19 as a trigger of irritable bowel syndrome: a review of potential mechanisms. World J Gastroenterol. 2021;27:7433–45.CrossRefPubMedPubMedCentral
17.
go back to reference Segal JP, Mak JWY, Mullish BH, Alexander JL, Ng SC, Marchesi JR. The gut microbiome: an under-recognised contributor to the COVID-19 pandemic? Therap Adv Gastroenterol. 2020;13:1756284820974914.CrossRefPubMedPubMedCentral Segal JP, Mak JWY, Mullish BH, Alexander JL, Ng SC, Marchesi JR. The gut microbiome: an under-recognised contributor to the COVID-19 pandemic? Therap Adv Gastroenterol. 2020;13:1756284820974914.CrossRefPubMedPubMedCentral
18.
go back to reference Yamamoto R, Kaito D, Homma K, Endo A, Tagami T, Suzuki M, et al. Early intubation and decreased in-hospital mortality in patients with coronavirus disease 2019. Crit Care. 2022;26:124.CrossRefPubMedPubMedCentral Yamamoto R, Kaito D, Homma K, Endo A, Tagami T, Suzuki M, et al. Early intubation and decreased in-hospital mortality in patients with coronavirus disease 2019. Crit Care. 2022;26:124.CrossRefPubMedPubMedCentral
19.
go back to reference Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol. 1997;32:920–4.CrossRefPubMed Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol. 1997;32:920–4.CrossRefPubMed
20.
go back to reference Fukudo S, Okumura T, Inamori M, Okuyama Y, Kanazawa M, Kamiya T, et al. Evidence-based clinical practice guidelines for irritable bowel syndrome 2020. J Gastroenterol. 2021;56:193–217.CrossRefPubMedPubMedCentral Fukudo S, Okumura T, Inamori M, Okuyama Y, Kanazawa M, Kamiya T, et al. Evidence-based clinical practice guidelines for irritable bowel syndrome 2020. J Gastroenterol. 2021;56:193–217.CrossRefPubMedPubMedCentral
21.
go back to reference Mearin F, Lacy BE, Chang L, Chey WD, Lembo AJ, Simren M, et al. Bowel disorders. Gastroenterology. 2016;S0016–5085(16):00222–5. Mearin F, Lacy BE, Chang L, Chey WD, Lembo AJ, Simren M, et al. Bowel disorders. Gastroenterology. 2016;S0016–5085(16):00222–5.
22.
go back to reference Palazón-Bru A, Folgado-de la Rosa DM, Cortés-Castell E, López-Cascales MT, Gil-Guillén VF. Sample size calculation to externally validate scoring systems based on logistic regression models. PLoS ONE. 2017;12:e0176726.CrossRefPubMedPubMedCentral Palazón-Bru A, Folgado-de la Rosa DM, Cortés-Castell E, López-Cascales MT, Gil-Guillén VF. Sample size calculation to externally validate scoring systems based on logistic regression models. PLoS ONE. 2017;12:e0176726.CrossRefPubMedPubMedCentral
23.
go back to reference Steyerberg EW, Harrell FE Jr, Borsboom GJJM, Eijkemans MJC, Vergouwe Y, Habbema JDF. Internal validation of predictive models: efficiency of some procedures for logistic regression analysis. J Clin Epidemiol. 2001;54:774–81.CrossRefPubMed Steyerberg EW, Harrell FE Jr, Borsboom GJJM, Eijkemans MJC, Vergouwe Y, Habbema JDF. Internal validation of predictive models: efficiency of some procedures for logistic regression analysis. J Clin Epidemiol. 2001;54:774–81.CrossRefPubMed
24.
go back to reference Jiang X, Luo M, Zou Z, Wang X, Chen C, Qiu J. Asymptomatic SARS-CoV-2 infected case with viral detection positive in stool but negative in nasopharyngeal samples lasts for 42 days. J Med Virol. 2020;92:1807–9.CrossRefPubMedPubMedCentral Jiang X, Luo M, Zou Z, Wang X, Chen C, Qiu J. Asymptomatic SARS-CoV-2 infected case with viral detection positive in stool but negative in nasopharyngeal samples lasts for 42 days. J Med Virol. 2020;92:1807–9.CrossRefPubMedPubMedCentral
25.
go back to reference Lamers MM, Beumer J, van der Vaart J, Knoops K, Puschhof J, Breugem TI, et al. SARS-CoV-2 productively infects human gut enterocytes. Science. 2020;369:50–4.CrossRefPubMed Lamers MM, Beumer J, van der Vaart J, Knoops K, Puschhof J, Breugem TI, et al. SARS-CoV-2 productively infects human gut enterocytes. Science. 2020;369:50–4.CrossRefPubMed
26.
go back to reference Iacob T, Țățulescu DF, Lupșe MS, Dumitrașcu DL. Post-infectious irritable bowel syndrome after a laboratory-proven enteritis. Exp Ther Med. 2020;20:3517–22.PubMedPubMedCentral Iacob T, Țățulescu DF, Lupșe MS, Dumitrașcu DL. Post-infectious irritable bowel syndrome after a laboratory-proven enteritis. Exp Ther Med. 2020;20:3517–22.PubMedPubMedCentral
27.
go back to reference Hashimoto T, Perlot T, Rehman A, Trichereau J, Ishiguro H, Paolino M, et al. ACE2 links amino acid malnutrition to microbial ecology and intestinal inflammation. Nature. 2012;487:477–81.CrossRefPubMedPubMedCentral Hashimoto T, Perlot T, Rehman A, Trichereau J, Ishiguro H, Paolino M, et al. ACE2 links amino acid malnutrition to microbial ecology and intestinal inflammation. Nature. 2012;487:477–81.CrossRefPubMedPubMedCentral
28.
go back to reference Zhang H, Li HB, Lyu JR, Lei XM, Li W, Wu G, et al. Specific ACE2 expression in small intestinal enterocytes may cause gastrointestinal symptoms and injury after 2019-nCoV infection. Int J Infect Dis. 2020;96:19–24.CrossRefPubMedPubMedCentral Zhang H, Li HB, Lyu JR, Lei XM, Li W, Wu G, et al. Specific ACE2 expression in small intestinal enterocytes may cause gastrointestinal symptoms and injury after 2019-nCoV infection. Int J Infect Dis. 2020;96:19–24.CrossRefPubMedPubMedCentral
29.
go back to reference Austhof E, Bell ML, Riddle MS, Catalfamo C, McFadden C, Cooper K, et al. Persisting gastrointestinal symptoms and post-infectious irritable bowel syndrome following SARS-CoV-2 infection: results from the Arizona CoVHORT. Epidemiol Infect. 2022;150:e136.CrossRefPubMed Austhof E, Bell ML, Riddle MS, Catalfamo C, McFadden C, Cooper K, et al. Persisting gastrointestinal symptoms and post-infectious irritable bowel syndrome following SARS-CoV-2 infection: results from the Arizona CoVHORT. Epidemiol Infect. 2022;150:e136.CrossRefPubMed
30.
go back to reference Noviello D, Costantino A, Muscatello A, Bandera A, Consonni D, Vecchi M, et al. Functional gastrointestinal and somatoform symptoms five months after SARS-CoV-2 infection: A controlled cohort study. Neurogastroenterol Motil. 2022;34:e14187.CrossRefPubMed Noviello D, Costantino A, Muscatello A, Bandera A, Consonni D, Vecchi M, et al. Functional gastrointestinal and somatoform symptoms five months after SARS-CoV-2 infection: A controlled cohort study. Neurogastroenterol Motil. 2022;34:e14187.CrossRefPubMed
31.
go back to reference Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395:1033–4.CrossRefPubMedPubMedCentral Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395:1033–4.CrossRefPubMedPubMedCentral
32.
go back to reference Ju Y, Chen W, Liu J, Yang A, Shu K, Zhou Y, et al. Effects of centralized isolation vs home isolation on psychological distress in patients with COVID-19. J Psychosom Res. 2021;143:110365.CrossRefPubMedPubMedCentral Ju Y, Chen W, Liu J, Yang A, Shu K, Zhou Y, et al. Effects of centralized isolation vs home isolation on psychological distress in patients with COVID-19. J Psychosom Res. 2021;143:110365.CrossRefPubMedPubMedCentral
33.
go back to reference Holtmann GJ, Ford AC, Talley NJ. Pathophysiology of irritable bowel syndrome. Lancet Gastroenterol Hepatol. 2016;1:133–46.CrossRefPubMed Holtmann GJ, Ford AC, Talley NJ. Pathophysiology of irritable bowel syndrome. Lancet Gastroenterol Hepatol. 2016;1:133–46.CrossRefPubMed
Metadata
Title
Early symptoms preceding post-infectious irritable bowel syndrome following COVID-19: a retrospective observational study incorporating daily gastrointestinal symptoms
Authors
Ryo Yamamoto
Asako Yamamoto
Tatsuhiro Masaoka
Koichiro Homma
Tadashi Matsuoka
Ryo Takemura
Michihiko Wada
Junichi Sasaki
Keio Donner Project
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Gastroenterology / Issue 1/2023
Electronic ISSN: 1471-230X
DOI
https://doi.org/10.1186/s12876-023-02746-y

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