COVID-19 as a trigger of irritable bowel syndrome: A review of potential mechanisms

Abstract

In December 2019 a novel coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), started spreading from Wuhan city of Chinese Hubei province and rapidly became a global pandemic. Clinical symptoms of the disease range from paucisymptomatic disease to a much more severe disease. Typical symptoms of the initial phase include fever and cough, with possible progression to acute respiratory distress syndrome. Gastrointestinal manifestations such as diarrhoea, vomiting and abdominal pain are reported in a considerable number of affected individuals and may be due to the SARS-CoV-2 tropism for the peptidase angiotensin receptor 2. The intestinal homeostasis and microenvironment appear to play a major role in the pathogenesis of COVID-19 and in the enhancement of the systemic inflammatory responses. Long-term consequences of COVID-19 include respiratory disturbances and other disabling manifestations, such as fatigue and psychological impairment. To date, there is a paucity of data on the gastrointestinal sequelae of SARS-CoV-2 infection. Since COVID-19 can directly or indirectly affect the gut physiology in different ways, it is plausible that functional bowel diseases may occur after the recovery because of potential pathophysiological alterations (dysbiosis, disruption of the intestinal barrier, mucosal microinflammation, post-infectious states, immune dysregulation and psychological stress). In this review we speculate that COVID-19 can trigger irritable bowel syndrome and we discuss the potential mechanisms.

Keywords: SARS-CoV-2; COVID-19; Irritable bowel syndrome; Microbiota; Dysbiosis; Gut-brain axis

Core Tip: Coronavirus disease 2019 (COVID-19) is not only a respiratory tract illness, as it may involve other systems, including the gastrointestinal tract. Persistent symptoms after the resolution of the infection are described, but there is almost no mention on the possible consequences on bowel function. However, some aspects concerning COVID-19, its management, and psychological aspects, may contribute to trigger disorders of the gut-brain interaction, among which the irritable bowel syndrome is the most frequent.