How Covid-19 and mental health affected IBS
Irritable bowel syndrome (IBS) is one of the most commonly diagnosed chronic gastrointestinal disorders characterized by the presence of recurrent abdominal pain or discomfort, with altered bowel habits, in other words, it can cause diarrhea or constipation. [2,6] There have been gastrointestinal manifestations of the coronavirus disease 2019 (COVID‐19) pandemic may mimic irritable bowel syndrome (IBS). How is IBS linked to COVID-19? [1,2,6]
As natural and normal reactions to the changing and uncertain situation that everyone finds themselves in, stress appears in form of widespread concern, fear, depression and anxiety. This defines the times we are all facing in COVID-19 right now. [1]
In recent psychological studies have suggested IBS has association with psychological factors. Both journals; “Journal of Clinical Gastroenterology” and “Journal of gastroenterology and hepatology” published articles with same object of learning impact of COVID-19 PANDEMIC on individuals with IBS resulting in association of increase psychological distress and gastrointestinal symptoms among individuals with IBS and comorbid anxiety and/or depression. [8,9]
In order to understand how those studies arrived to that conclusion, we must tackle how anxiety and stress impact our gut system. Being under stress for long term affects mental health and thus affect how body functions. This shows how the brain and the gut interaction has been recently recognized in the pathophysiology of the irritable bowel syndrome. This is because of the bidirectional communication between central nervous system and enteric nervous system as the brain can influence the function of the enteric nervous system and the gut can influence the brain via vagal and sympathetic afferents. In patients with irritable bowel syndrome, symptoms may be caused by alterations either primarily in the central nervous system (top-down model), or in the gut (bottom-up model), or in a combination of both. Therefore, the brain–gut axis may be stimulated by various stressors either directed to the central nervous system (exteroreceptive stress) or to the gut (interoceptive stress).[10]
In addition, another stressful factor in past year increased due to COVID-19 lockdown which is domestic violence. according to UNwomen, in the previous 12 months, 243 million women and girls (aged 15-49) across the world have been subjected to sexual or physical violence. There are ongoing studies continue to show that abuse can have multiple effects on GI symptoms, patient illness behaviors, and clinical outcomes. Looking at past figures, psychosocial factors may also predispose to the development of IBS. Women with IBS are more likely to have experienced verbal, sexual, or physical abuse, which can contribute to the development of the disease through brain-gut and mucosal immune dysfunction.[2]
A note to take home, that fear, anxiety, depression and violence caused by COVID-19 isolation and mental illnesses such as major depression, anxiety, and somatization share in aggravating the symptoms of IBS seen in biophysiological relationship between brain and gastointestinal mesenteric nervous system and resulting in gastrointestinal symptoms in non-IBS patients. Simply, Irritable bowel syndrome is a heterogeneous disease, and the comorbidity of IBS and psychological distress is common.
References:
1.Kontoangelos, K., Economou, M., & Papageorgiou, C. (2020). Mental health effects of covid-19 pandemia: A review of clinical and psychological traits. Psychiatry Investigation, 17(6), 491-505. doi:10.30773/pi.2020.0161
2.Chey, W. D., Kurlander, J., & Eswaran, S. (2015). Irritable Bowel Syndrome. JAMA, 313(9), 949. doi:10.1001/jama.2015.0954
3.Riedl A, Schmidtmann M, Stengel A, et al. Somatic comorbidities of irritable bowel syndrome:a systematic analysis. J Psychosom Res. 2008;64 (6):573-582.
4.Lovell RM, Ford AC. Prevalence of gastro-esophageal reflux-type symptoms in individuals with irritable bowel syndrome in the community: a meta-analysis. Am J Gastroenterol.2012;107(12):1793-1801.
5.Ford AC, Marwaha A, Lim A, Moayyedi P. Systematic review and meta-analysis of the prevalence of irritable bowel syndrome in individuals with dyspepsia. Clin Gastroenterol Hepatol. 2010;8(5):401-409.
6.Fond G, Loundou A, Hamdani N, et al. Anxiety and depression comorbidities in irritable bowel syndrome (IBS): a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci. 2014;264(8):651-660.
7.Drossman DA. Abuse, trauma, and GI illness: is there a link? Am J Gastroenterol. 2011;106(1):14-25.
8.Kamp, K. J., Levy, R. L., Munson, S. A., & Heitkemper, M. M. (2021). Impact of covid-19 on individuals with irritable bowel syndrome AND COMORBID anxiety and/or depression. Journal of Clinical Gastroenterology, Publish Ahead of Print. doi:10.1097/mcg.0000000000001515
- Quek, S. X., Loo, E. X., Demutska, A., Chua, C. E., Kew, G. S., Wong, S., . . . Siah, K. T. (2021). Impact of the CORONAVIRUS disease 2019 pandemic on irritable bowel syndrome. Journal of Gastroenterology and Hepatology. doi:10.1111/jgh.15466
