Gut-Brain Disorders Surge After Pandemic

There’s been a striking rise in disorders of gut-brain interaction (DGBI), including irritable bowel syndrome (IBS) and functional dyspepsia, since the COVID-19 pandemic, new survey data from the UK and the US showed.

“Healthcare providers should recognize post-COVID DGBI as part of the long COVID spectrum. These post-COVID gut problems appear more severe and require more medical care than similar pre-pandemic conditions,” Imran Aziz, MBChB, MD, honorary consultant gastroenterologist and senior clinical lecturer, Sheffield Teaching Hospitals NHS Foundation Trust and University of Sheffield, Sheffield, England, told Medscape Medical News.

Aziz and colleagues surveyed a nationally representative sample of 4050 adults in the UK and the US in 2017 (pre-pandemic) and repeated the survey in 4002 adults in 2023 (post-pandemic).

The surveys included the Rome IV diagnostic questionnaire for DGBI and questions about nongastrointestinal somatic symptoms, anxiety and depression, quality of life, and healthcare use.

The 2023 survey also asked about COVID-19 infection and illness history.

The overall prevalence of DGBI (ie, meeting diagnostic criteria for at least one DGBI) increased significantly from the pre- to post-pandemic era (38% vs 47%; odds ratio [OR], 1.20), with similar findings independently noted in both countries.

From pre- to post-pandemic, the rise in DGBI was observed within the esophageal (9% vs 10%; OR, 1.16), gastroduodenal (12% vs 16%; OR, 1.45), and bowel domains (30% vs 33%; OR, 1.12).

Functional dyspepsia rose nearly 44% — from 8% to 12% (OR, 1.48) — and IBS increased 28% — from 5% to 6% (OR, 1.31).

The rise in DGBI has been seen in both men and women and across all adult age groups.

Multiple Factors at Play

Aziz told Medscape Medical News the uptick is probably due to not only the direct impact of SARS-CoV-2 infection on the gastrointestinal tract but also to the psychological stress associated with pandemic life.

“In this study, we found that COVID-viral related factors contributing to DGBI include number of infections, abdominal pain and/or diarrhea during COVID-19 infection, and long COVID,” he explained.

“We also observed increased mood disturbances among people with DGBI in the post-pandemic era, but this study did not determine the direction of causality. Previous studies have shown that in one third of DGBI cases the mood disturbance precedes gut symptoms, while in two third of cases gut symptoms precede mood disturbances,” Aziz noted.

The study was published online on July 30 in Clinical Gastroenterology and Hepatology.

The results are in line with a recent study that found the prevalence of IBS and chronic idiopathic constipation among US adults rose significantly during the COVID-19 pandemic, with a near doubling of the national rate of IBS over 2 years, as reported previously by Medscape Medical News.

Given a lack of high-quality clinical trials specifically for post-COVID DGBI management, “healthcare providers should follow existing standard guidelines for functional dyspepsia and IBS,” Aziz advised.

“The established treatment protocols remain our best approach until more targeted research becomes available. It’s also important to take a holistic approach. This means addressing not just the gut symptoms but also any accompanying mood disturbances. Many long-COVID clinics already provide this multiintegrated care model, which appears to be the most effective approach,” Aziz said.

The 2017 survey was funded by the Rome Foundation, while the 2023 survey was funded by Tillotts Pharma and Novonesis. The funders had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Aziz has received speaker fees from PrecisionBiotics.