COVID's Gut Punch: Some GI Disorders Rose Post-Pandemic

 

• The prevalence of disorders of gut-brain interaction rose from 38.3% before the COVID-19 pandemic to 42.6% afterward.
• The largest increases were observed in conditions including functional dyspepsia and irritable bowel syndrome.
• Factors associated with having these disorders in the post-pandemic era included younger age, female sex, anxiety, depression, increasing number of COVID infections, and experiencing abdominal pain or diarrhea during COVID infections.

Disorders of gut-brain interaction -- such as irritable bowel syndrome (IBS) -- rose significantly in both the U.S. and the U.K. following the COVID-19 pandemic, according to a population-based survey study.

Surveys revealed that the proportion of adults meeting criteria for at least one such disorder increased from 38.3% in 2017 to 42.6% in 2023 (OR 1.20, 95% CI 1.09-1.31), Imran Aziz, MD, of the University of Sheffield in England, and colleagues reported in Clinical Gastroenterology and Hepatologyopens in a new tab or window.

"The COVID-19 pandemic has significantly increased functional gut problems," Aziz told MedPage Today in an email. "Healthcare providers should recognize post-COVID [disorders of gut-brain interaction] as part of the long COVID spectrum."

"These post-COVID gut problems appear more severe, and require more medical care, than similar pre-pandemic conditions," he added.

The study is believed to be the first to directly compare the prevalence and burden of these disorders before and after the pandemic in two separate countries using the same methodology.

Kristen Pogreba-Brown, PhD, MPH, a University of Arizona epidemiologist who was not involved in the study, is leading a similar projectopens in a new tab or window examining IBS and other gastrointestinal symptoms as a condition of long COVID. She told MedPage Today that the study benefitted from a “perfect scenario” and produced a “really nice, rich data set.”

She added that the results are “pretty consistent” with her findings to date.

“My takeaway would be that the majority of the increase that they’re seeing is due to the infection itself,” Pogreba-Brown said.

The most significant increase was observed in the gastroduodenal domain, with prevalence rising from 11.9% to 16.4% overall (OR 1.45, 95% 1.28-1.65). This was mainly accounted for by an increase in the prevalence of functional dyspepsia (8.3% vs 11.9%, OR 1.48), which included rises in postprandial distress syndrome, epigastric pain syndrome, chronic nausea and vomiting syndrome, and cyclic vomiting syndrome.

There was also an increase in the esophageal domain (8.8% vs 10.1%, OR 1.16) that was accounted for by an increase in functional dysphagia (4.7% vs 5.7%, OR 1.23).

And there was an increase in the bowel domain (30.1% vs 32.5%, OR 1.12), with an increase in IBS of 4.7% to 6% (OR 1.31). There were also increases in functional bloating and distention.

The researchers noted that the overall increase in prevalence of disorders of gut-brain interaction occurred independently in both the U.S. (39.9% to 44%, OR 1.18, 95% CI 1.04-1.34) and the U.K. (36.7% to 41.2%, OR 1.21, 95% CI 1.07-1.38).

In a multivariate analysis, factors associated with having these disorders in the post-pandemic era included younger age, female sex, anxiety, depression, increasing number of COVID infections, and experiencing abdominal pain or diarrhea during COVID infections, they noted.

"For managing post-COVID IBS, it's crucial to take a holistic approach," Aziz said. "This means addressing not just the gut symptoms but also any accompanying mood disturbances."

While the findings are based on data from two countries, Aziz said they are likely generalizable worldwide due to the global spread of COVID. However, he added that differences in healthcare systems and societal factors could affect the extent of the impact.

"Healthcare services and research funding bodies should prepare for this increase in ... cases and develop optimal management strategies for this growing patient population," Aziz said.

In the absence of targeted clinical trials specifically at these conditions, the researchers recommended clinicians follow existing guidelines for managing functional dyspepsia and IBS.

"The established treatment protocols remain our best approach until more targeted research becomes available," Aziz said.

For their study, the researchers conducted internet-based surveys using pre-defined demographic quotas in 2017 and again in 2023. The surveys included 4,050 participants in 2017 and 4,002 in 2023, matched by age and sex. Both used the Rome IV diagnostic questionnaire and included assessments of somatic symptoms, mood, quality of life, and healthcare utilization.

The 2023 survey also included questions about COVID-19, including infection and illness history.

Limitations included the study's cross-sectional design, reliance on self-reported data, and a lack of pediatric representation. Also, while noting that mood disturbances were associated with disorders of gut-brain interaction, the direction of causality remains unclear.

Disclosures

The 2017 survey was funded by the Rome Foundation and the 2023 survey was funded by Tillotts Pharma AG and Novonesis A/S.

Aziz reported receiving speaker fees from PrecisionBiotics. Co-authors disclosed relationships with AbbVie, Alfasigma, BioGaia, Biocodex, Bromatech, Cinclus, Danone Nutricia Research, Genetic Analysis AS, Kyowa Kirin, Janssen, Mayoly, Pfizer, Renapharma, Sanofi, Tillotts, and Takeda.

Primary Source

Clinical Gastroenterology and Hepatology

Source Reference: opens in a new tab or windowPalsson O, et al "The prevalence and burden of disorders of gut-brain interaction (DGBI) before versus after the COVID-19 Pandemic" Clin Gastroenterol Hepatol 2025; DOI: 10.1016/j.cgh.2025.07.012.

https://www.medpagetoday.com/gastroenterology/generalgastroenterology/116770