Neurogastroenterology Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK.
Neurogastroenterol Motil. 2022 Sep;34(9):e14347. doi: 10.1111/nmo.14347. Epub 2022 Mar 3.
The COVID-19 pandemic caused unprecedented disruption to healthcare services worldwide with well-documented detrimental effects on mental health. Patients with refractory disorders of gut-brain interaction such as Irritable Bowel Syndrome (IBS) seen in tertiary care tend to exhibit higher levels of psychological comorbidity, but the impact of the pandemic on IBS symptom severity in tertiary care is unknown.
As part of routine clinical care, consecutive tertiary referrals with refractory IBS patients prospectively completed a series of baseline questionnaires including IBS symptom severity score (IBS-SSS), non-colonic symptom score, Hospital Anxiety and Depression (HAD), and Illness impact scores. The symptom severity questionnaire data were compared for consecutive patients seen in tertiary care 12 months before and after the onset of COVID-19 pandemic restrictions.
Of 190 consecutive tertiary referrals with IBS, those seen during the pandemic had greater IBS severity (IBS-SSS: 352 vs. 318, p = 0.03), more severe extra-intestinal symptoms (non-colonic score: 269 vs. 225, p = 0.03), sleep difficulties (p = 0.03), helplessness and loss of control (p = 0.02), but similar HAD-Anxiety (p = 0.96) and HAD-Depression (p = 0.84) scores. During the pandemic, unmarried patients (p = 0.03), and keyworkers (p = 0.0038) had greater IBS severity.
This study has shown for the first time that patients seen in tertiary care with refractory IBS during the COVID-19 pandemic had a significantly higher symptom burden emphasizing the importance of gut-brain axis in IBS. Furthermore, lack of support and perceived loss of control appear to be contributory factors.
COVID-19 大流行给全球医疗服务带来了前所未有的破坏，对心理健康造成了有据可查的不利影响。在三级保健中观察到的难治性肠脑相互作用障碍（如肠易激综合征[IBS]）患者往往表现出更高水平的心理共病，但大流行对三级保健中 IBS 症状严重程度的影响尚不清楚。
作为常规临床护理的一部分，连续三级转诊的难治性 IBS 患者前瞻性地完成了一系列基线问卷，包括 IBS 症状严重程度评分（IBS-SSS）、非结肠症状评分、医院焦虑和抑郁量表（HAD）和疾病影响评分。比较了 COVID-19 大流行限制前后连续 12 个月在三级保健中就诊的患者的症状严重程度问卷数据。
在 190 例连续的 IBS 三级转诊患者中，在大流行期间就诊的患者 IBS 严重程度更高（IBS-SSS：352 对 318，p=0.03），非结肠症状更严重（非结肠评分：269 对 225，p=0.03），睡眠困难（p=0.03），无助和失控（p=0.02），但 HAD 焦虑（p=0.96）和 HAD 抑郁（p=0.84）评分相似。在大流行期间，未婚患者（p=0.03）和关键工人（p=0.0038）的 IBS 严重程度更高。
这项研究首次表明，在 COVID-19 大流行期间，在三级保健中就诊的难治性 IBS 患者的症状负担明显更高，这强调了肠脑轴在 IBS 中的重要性。此外，缺乏支持和感知到的失控似乎是促成因素。
