The risk of irritable bowel syndrome is 6 times higher in hospitalized COVID-19 patients! Diagnosis and medication should be paid attention to

Recently, researchers from the University of Bologna in Italy published a research paper titled "Post COVID-19 irritable bowel syndrome" in the top journal of gastrointestinal diseases "Gut".

The study showed that within one year of infection with the new coronavirus, hospitalized patients had a six-fold higher incidence of irritable bowel syndrome and a higher risk of depression compared with the control group.

Irritable bowel syndrome

Irritable bowel syndrome (IBS) has abdominal pain, bloating or discomfort as its main symptoms, which are related to defecation or accompanied by changes in bowel habits such as frequency and/or stool characteristics. Routine clinical examinations have not yet revealed any organic diseases that can explain these symptoms.
Based on the main stool characteristics of patients with abnormal bowel movements, IBS is divided into four types: constipation-predominant IBS (IBS-C), diarrhea-predominant IBS (IBS-D), mixed IBS (IBS-M) and unclassified IBS (IBS-U).

Diagnosis of Irritable Bowel Syndrome

Alternating diarrhea and constipation is a common manifestation of incomplete intestinal obstruction (colon cancer, diverticular disease) and irritable bowel syndrome.
Common clinical features of irritable bowel syndrome: more common in young women (21-40 years old); may develop after gastroenteritis or traveler's diarrhea; compressive abdominal pain (central or iliac fossa); abdominal pain can be relieved after passing gas or defecation; changeable bowel habits, constipation is more common; diarrhea is often obvious in the morning - unformed, urgent explosive bowel movements; often induced by eating; stools are sometimes hard and ball-like or ribbon-like; anorexia, nausea (sometimes occur); abdominal distension, bowel sounds; often feel tired.

IBS is a functional disease, so diagnosis by exclusion is important.

For high-risk groups or high-risk symptoms such as those aged > 40 years, with blood in the stool, positive fecal occult blood test, nocturnal bowel movements, anemia, abdominal mass, ascites, fever, unintentional weight loss, family history of colorectal cancer and IBD, it is recommended to complete auxiliary examinations such as colonoscopy to exclude organic diseases before making a diagnosis.

At present, the IBS criteria commonly used in secondary medical institutions are the Rome IV criteria published in 2016, which state that symptoms must have occurred for at least 6 months before diagnosis and meet the following criteria in the past 3 months: recurrent abdominal pain, with an average of at least 1 day/week in the past 3 months, combined with 2 or more of the following:

(1) Abdominal pain is related to defecation; (2) Attacks are accompanied by changes in bowel movement frequency; (3) Attacks are accompanied by changes in stool characteristics (appearance).

The following symptoms are not required for diagnosis, but their presence supports the diagnosis of IBS:

(1) Abnormal bowel movement frequency: less than 3 bowel movements per week or more than 3 bowel movements per day; (2) Abnormal bowel movement characteristics: lumpy/hard stools or mushy/watery stools; (3) Straining during bowel movements; (4) Feeling of urgency during bowel movements or a feeling of incomplete bowel movements; (5) Passage of mucus in the stool; (6) Abdominal distension.

In addition, other digestive tract diseases (such as appendicitis, gallbladder disease, ulcers, and tumors) can induce IBS. If a patient has rare symptoms of IBS , further examination is required.

IBS does not lead to malignancy or inflammatory bowel disease, nor does it shorten life expectancy.

Dietary modification and non-drug treatments

Treatment varies from person to person, but the basis of initial treatment is simple dietary modifications**** and non-drug treatments . If specific foods or certain types of stress trigger the condition, these foods and stress should be avoided as much as possible. For example, people with bloating and flatulence should avoid beans, cabbage, and other foods that are difficult to digest; avoid large amounts of foods, medications, and chewing gum with artificial sweeteners such as sorbitol, and eat fructose in small amounts. For people with IBS who present with constipation, regular physical activity can help restore and maintain normal gastrointestinal function.

Appropriate medication can relieve symptoms

IBS is a group of clinical syndromes characterized by abdominal pain. The main cause of abdominal pain is smooth muscle spasm, so spasmolytics such as pinaverium bromide, otilonium bromide, and alverine can relieve abdominal pain symptoms. Many international guidelines and consensus opinions recommend spasmolytics as the first-line medication for improving IBS abdominal pain symptoms, but some experts have suggested that spasmolytics may aggravate the constipation symptoms of IBS-C.

In addition, many studies have shown that IBS patients have intestinal flora disorders, which may be related to the occurrence and development of IBS. In recent years, many randomized controlled trials have found that probiotics can relieve abdominal distension, abdominal pain, diarrhea and overall symptoms in IBS patients.

For patients with diarrhea, antidiarrheal drugs can be selected appropriately according to their condition; for patients with constipation, mild laxatives and prokinetic drugs can be taken.

In addition, psychological cognition and behavioral guidance are also necessary parts of IBS treatment.