Post-COVID-19 irritable bowel syndrome.

Editor,

We read with great interest the article by Blackett and colleagues describing new gastrointestinal (GI) symptoms at 6 months following COVID‐19 infection—echoing findings in our own study where we proposed the existence of a novel “post‐COVID‐19 irritable bowel syndrome (IBS).” Beckett et al. retrospectively reviewed medical records of 147 patients to identify that 16% reported new GI symptoms at a median follow‐up time of 106 days, and also conducted an online survey of self‐identified survivors of COVID‐19 infection, where 40% responders reported new GI symptoms at 6 months.

Post‐infectious IBS is a recognized phenomenon, first described in 1950 by Stewart, whereby GI symptoms may persist following clearance of an infecting enteric pathogen. COVID‐19 has overwhelmed healthcare services since 2019 and while acute GI symptoms have been well observed in addition to the classic viral/respiratory symptoms, less has been known about their persistence. Our prospective survey study examined the long‐term GI effects and showed that 43.8% of responders had new persistent GI symptoms at 6 months following their PCR diagnosis of COVID‐19; with abdominal pain (29.2%), diarrhea (18.8%), constipation (10.4%), nausea (10.4%), and dyspepsia (29.2%) being the most commonly reported symptoms. Of our responders, 39.1% were troubled by these symptoms every day; which would be compatible with Rome IV IBS diagnostic criteria.

A recent Nature review article by Meringer and Mehandru has further supported this phenomenon, as a “post‐acute COVID‐19 syndrome”; offering an overview of various potential mechanisms for its pathogenesis, including persistent inflammation, autoimmunity, persistence of viral antigen, altered cytokine production, prior mental health condition, maladaptive neuro‐immune interactions, and alteration to the fecal microbiome.

There is now growing evidence that post‐COVID‐19 IBS is a global problem. However, current understanding is limited by few and small studies. Further objective research is needed to investigate this condition further, ensuring that clinical assessment has ruled out non‐IBS pathology and accounting for the natural background incidence of IBS, which may be a confounding factor, so that the disease course can be better understood and response to therapies ascertained.

AUTHOR CONTRIBUTIONS

Dr J Cooney and Dr A Poullis contributed equally to the design and writing of this letter.

CONFLICT OF INTEREST

No conflicts of interest.