Intestinal microbiota, pain, dementia

The review is dedicated the interconnection between neurodegenerative diseases, chronic pain and gut microbiota's structure and function. The gut microbiota's role in gut-brain axis, neuroimmune interaction is considered. The modern data about gut dysbiosis in Alzheimer disease, Parkinson disease, osteoarthrosis, neuropathic pain in COVID infection, muscular-skeletal pain in fibromyalgia, irritable bowel syndrome et cetera are provided. The gut microbiota's modification by means of pre and probiotics in combination with medicines and diet modification can be used for the treatment of chronic pain and dementia.Copyright © T.M. MANEVICH.

Biofeedback Treatment Can Improve Clinical Condition and Quality of Life in Patients with Pelvic Floor Dyssynergy with Irritable Bowel Syndrome: A Prospective Cohort Study

Background: Chronic constipation is a common health concern. Defecatory disorders are considered one of the mechanisms of chronic idiopathic constipation. This study aimed to evaluate the effect of concurrent irritable bowel syndrome (IBS) on the success rate and response to biofeedback therapy in patients with chronic constipation and pelvic floor dyssynergia (PFD). Method(s): This prospective cohort study was performed at the Imam Khomeini Hospital Complex in Tehran from October 2020 to July 2021. Patients aged 18-70 years with chronic constipation and PFD confirmed by clinical examination, anorectal manometry, balloon expulsion test, and/or defecography were included. All patients failed to respond to treatment with lifestyle modifications and laxative use. The diagnosis of IBS was based on the ROME IV criteria. Biofeedback was educated and recommended to all patients. We used three different metrics to assess the patient's response to biofeedback: 1) constipation score (questionnaire), 2) lifestyle score (questionnaire), and 3) manometry findings (gastroenterologist report). Result(s): Forty patients were included in the final analysis, of which 7 men (17.5%) and 21 (52.2%) had IBS. The mean age of the study population was 37.7 +/- 11.4. The average resting pressure decreased in response to treatment;however, this decrease was statistically significant only in non-IBS patients (P = 0.007). Patients with and without IBS showed an increase in the percentage of anal sphincter relaxation in response to treatment, but this difference was not statistically significant. Although the first sensation decreased in both groups, this decrease was not statistically significant. Overall, the clinical response was the same across IBS and non-IBS patients, but constipation and lifestyle scores decreased significantly in both groups of patients with and without IBS (P < 0.001). Conclusion(s): Biofeedback treatment appears to improve the clinical condition and quality of life of patients with PFD. Considering that a better effect of biofeedback in correcting some manometric parameters has been seen in patients with IBS, it seems that paying attention to the association between these two diseases can be helpful in deciding on treatment.Copyright © 2023 The Author(s).

Centering Group Treatment for Women With Interstitial Cystitis/Bladder Pain Syndrome: A Prospective, Parallel-Group Cohort Study

Importance: Women with interstitial cystitis/bladder pain syndrome (ICBPS) face isolation and treatment challenges. Group medical visits using Centering models have successfully treated other conditions but have not been explored in ICBPS. Objective(s): This study aimed to describe ICBPS pain and symptom control comparing standard treatment alone versus standard treatment augmented with Centering visits. Study Design: This prospective cohort study recruited women with ICBPS receiving standard care (control) or standard care augmented with group Centering. We administered validated questionnaires at baseline and monthly for 12 months. The primary outcome was change in the pain numerical rating scale, with Patient-Reported Outcomes Measurement Information System Pain Interference Scale and Bladder Pain/Interstitial Cystitis Symptom Score change as secondary measures. Result(s): We enrolled 45 women (20 Centering, 25 controls). Centering had significantly better numerical rating scale pain scores at 1 month (mean difference [diff], -3.45) and 2 months (mean diff, -3.58), better Patient-Reported Outcomes Measurement Information System Pain Interference Scale scores at 1 month (mean diff, -10.62) and 2 months (mean diff, -9.63), and better Bladder Pain/Interstitial Cystitis Symptom Score scores at 2 months (mean diff, -13.19), and 3 months (mean diff, -12.3) compared with controls. In modeling, treatment group (Centering or control) and educational levels were both associated with all the outcomes of interest. Beyond 6 months, there were too few participants for meaningful analyses. Conclusion(s): Women with ICBPS participating in a Centering group have, in the short term, less pain, pain interference, and ICBPS-specific symptoms than patients with usual care alone. Larger studies with more follow-up are needed to determine if this treatment effect extends over time.Copyright © 2022 American Urogynecologic Society. All rights reserved.

Post-Covid-19 Irritable Bowel Syndrome

Background and aim: The long-term consequences of COVID- 19 infection on the gastrointestinal tract remain unclear. Here we aimed to evaluate the prevalence of gastrointestinal symptoms and post-COVID-19 disorders of gut-brain interaction (DGBI) after hospitalization for SARS-CoV-2 infection. Material(s) and Method(s): GI-COVID19 is a prospective, multicenter, controlled study. Patients with and without COVID-19 diagnosis were evaluated upon hospital admission and after 1, 6, and 12 months post-hospitalization. Gastrointestinal symptoms, anxiety, and depression were assessed using validated questionnaires, namely the Gastrointestinal Symptoms Rating Scale (GSRS), the Hanxiety and Depression Scale (HADS) and the Rome IV Diagnostic Questionnaire for Functional Gastrointestinal Disorders in Adults. Result(s): The study included 2183 hospitalized patients. The primary analysis included a total of 883 patients (614 COVID-19 patients and 269 controls) due to the exclusion of patients with pre-existing gastrointestinal symptoms and/or surgery. At enrollment, gastrointestinal symptoms were more frequent among COVID-19 patients than in the control group (59.3% vs. 39.7%, P<0.001). At the 12-month follow- up, constipation and hard stools were significantly more prevalent in controls than in COVID-19 patients (16% vs. 9.6%, P=0.019 and 17.7% vs. 10.9%, P=0.011, respectively). Compared to controls, COVID- 19 patients reported higher rates of irritable bowel syndrome (IBS) according to Rome IV criteria: 0.5% vs. 3.2%, P=0.045. Factors significantly associated with IBS diagnosis included history of allergies, chronic intake of proton pump inhibitors, and presence of dyspnea. [Table presented] At the 6-month follow-up, the rate of COVID-19 patients fulfilling the criteria for depression was higher than among controls. Conclusion(s): Compared to controls, hospitalized COVID-19 patients had fewer complaints of constipation and hard stools at 12 months after acute infection. COVID-19 patients had significantly higher rates of IBS than controls. ClinicalTrials.gov number, NCT04691895.Copyright © 2023. Editrice Gastroenterologica Italiana S.r.l.

Incidence and predisposing factors for de novo post-COVID-19 irritable bowel syndrome

Objective: Postinfectious irritable bowel syndrome (IBS) is a known entity. We evaluated the incidence of post-COVID-19 IBS in patients discharged from the hospital and analyzed its correlation with the clinical and laboratory parameters, and treatment during the hospital stay. Methods: Three hundred three COVID-19 hospitalized patients without prior history of IBS were prospectively followed after their discharge and were evaluated as per Rome-IV criteria for IBS. Results: One hundred seventy-eight patients were males (58.7%). The age range was 17-95 years (mean +or- SD, 55.9 +or- 15.8). A total of 194 (64%) had mild COVID-19, 74 (24.4%) had moderate COVID-19, whereas 35 (11.6%) had severe COVID-19 infection. Sixteen (5.3%) patients had concomitant GI symptoms during COVID-19 infection. IBS symptoms were found to be present in 32 (10.6%) patients, out of which 17 (53.13%) had diarrhea-predominant, 10 (31.25%) had constipation-predominant, and five (15.62%) had mixed-type IBS. Post-COVID-19 IBS was more common in the female sex (P < 0.001), concomitant GI symptoms with COVID-19 (P < 0.001), oxygen requirement (P = 0.015), deranged liver function tests at the time of admission (P = 0.002), high procalcitonin (P = 0.013), high C-reactive protein levels (P = 0.035);whereas negative correlation was found with remdesivir treatment (P = 0.047). After performing regression analysis, female sex (P < 0.001), oxygen requirement during hospital stay (P = 0.016), GI symptoms during COVID-19 infection (P < 0.001), and high procalcitonin levels (P = 0.017) were independently associated with post-COVID-19 IBS. Conclusion: GI symptoms during active COVID-19 infection increase the chances of developing post-COVID-19 IBS. The risk of developing post-COVID-19 IBS increases in female patients, those requiring oxygen and having high procalcitonin levels during COVID-19 infection.

Interoceptive Abilities in Irritable Bowel Sydrome from Long Covid Disease

SCOPO DEL LAVORO: Long COVID is defined as the continuation of symptoms much longer than usually expected or the persistence of symptoms despite the recovery of the infection. While research on long COVID is in full swing, only little attention has been paid to the associated psychiatric symptoms. In particular, the association between long COVID and somatic symptom disorders (SSD) has been overlooked. Beyond anxiety and depression symptoms, patients with COVID-19 present a high risk to develop SSD. SSD, previously known as somatoform disorders, have been defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as persistent and clinically significant somatic symptoms accompanied by excessive and disproportionate health-related thoughts, feelings and behaviours regarding the symptoms. Noviello et Al (2021) in their study show that acute SARS-CoV-2 infection may affect the brain-gut axis. Five months after the acute infection, mild gastroenterological symptoms persist, in particular in patients reporting diarrhea in the acute phase of the infection. Infected patients are also at increased risk of chronic fatigue and somatoform disorders, thus supporting the hypothesis that both functional gastrointestinal (like IBS) and somatoform disorders may have a common biological origin. IBS present an impairment in interoception and high levels of alexithymia. Interoception refers to the ability to accurately detect internal body changes. Alexithymia is a personality construct that implies difficulties identifying and describing one's own feelings, limited imaginative processes, an externally oriented cognitive style, and difficulties in distinguishing between feelings and bodily sensations. This construct is associated with many disorders, such as gastrointestinal pathologies. Given the relationship between long covid disease and gastrointestinal somatoform disorders (like IBS), and between interoceptive abilities and Irritable Bowel Syndrome, then it's conceivable a mediating role of interoceptive abilities in long covid IBS that deserves to be analyzed. MATERIALI E METODI: Subjects: All the patients aged between 18 and 60 years who tested positive at least 5 months before. Measures: - Toronto Alexithymia Scale - Hospital Anxiety and Depression Scale - Structured Assessment of Gastrointestinal Symptoms (SAGIS) questionnaire - Heart Rate Variability - Blood samples were collected between 8:30 am and 9:00 am. RISULTATI: There is a deficiency in interoceptive skills and high levels of alexithymia in patients with IBS and who have been infected with covid. CONCLUSIONI: In a current society, undermined by the psychophysical consequences of covid, Identifying factors that affect the well-being like Interoception training (as it is a learned skill), renders possible an intervention to modify some of these factors or promote a better understanding of patients with IBS who experience alternate periods of remission and relapse. .

Post-COVID-19 irritable bowel syndrome - importance of diet therapy and probiotic therapy

Introduction and Objective: The current challenge for medicine and the related disciplines is the development of methods and algorithms for dealing with the development of new diseases which undoubtedly include post-Covid-19 irritable bowel syndrome (P-IBS). This review is aimed at presentation of up-to-date scientific evidence on the impact of COVID-19 disease on development of post-Covid-19 irritable bowel syndrome. Review methods: The literature was reviewed using search engine data from PubMed, Google Scholar and the Medline databases. Brief description of the state of knowledge: At present, there are no guidelines or recommendations concerning therapeutic management of patients with post-Covid-19 irritable bowel syndrome. Therefore, the general standard of treatment for patients with irritable bowel syndrome (IBS) was reviewed. It is considered that the use of personalized low-FODMAP diet under the control of a clinical dietitian may be a good support in the treatment of IBS. Moreover, it seems advisable to supply personalized probiotic therapy based on the supplementation of strains with proven clinical effect. A new branch of probiotic therapy based on the use of psychobiotics in IBS patients as a form of support therapy also brings high hopes. Summary: The use of personalized low-FODMAP dietary supply and targeted probiotic therapy, including psychobiotherapy, could potentially be an effective method of supporting the treatment of patients suffering from post-Covid-19 irritable bowel syndrome. Currently, there are no guidelines for the routine use of the aforementioned methods. The need for further scientific research into the mechanisms of action and effectiveness of interventions in the context of P-IBS is indicated.

BLUE FINGERS, EOSINOPHILIC LUNGS: ACUTE EOSINOPHILIC PNEUMONIA FOLLOWING COVID-19 INFECTION

SESSION TITLE: Unique Inflammatory and Autoimmune Complications of COVID-19 Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Acute eosinophilic pneumonia is a rare illness characterized by eosinophilic infiltration of the lung parenchyma. Cases often present with fever, severe dyspnea, bilateral infiltrates, and eosinophilia on BAL exams. The cause of eosinophilic pneumonia is unknown, but is thought to be related to inhalational exposure of an irritant or toxin. Most cases are responsive to steroid treatment. This case demonstrates acute eosinophilic pneumonia in a patient who recently recovered from COVID-19 pneumonia. CASE PRESENTATION: A 50 year old female with a history of multiple sclerosis, seizure disorder secondary to MS, Irritable Bowel Syndrome, and a distant history of tobacco smoking and opiate dependence on chronic suboxone therapy, presented with dyspnea secondary to respiratory failure. The patient was urged to present by her husband after findings of hypoxia to 79% on room air with cyanosis of the lips and fingers. She recently recovered from COVID-19 1 month prior, at which time she had symptoms of cough productive of red mucus, fever, and exhaustion;but states she never returned to her baseline. With ongoing hypoxia, the patient was intubated for mechanical ventilation. Subsequent bronchoscopy with BAL resulted in a elevated eosinophil count to 76%, with fungal elements and PCR positive for HSV-1. The patient was initiated on high dose glucocorticoid therapy in addition to Acyclovir and Voriconazole. A CT with IV contrast revealed extensive bilateral pulmonary emboli involving the segmental and subsegmental branches throughout both lungs and extension into the right pulmonary artery;the patient was started on anticoagulation. Shortly after beginning glucocorticoid therapy, the patient had significant improvement and was able to be weaned off ventilation to simple nasal cannula. She was able to be safely discharged home with two liters of supplemental oxygen and steroid taper. DISCUSSION: Acute Eosinophilic pneumonia is a rare condition with an unknown acute disease process. The diagnostic criteria for acute eosinophilic pneumonia includes: a duration of febrile illness less than one month, hypoxia with an SpO2 <90%, diffuse pulmonary opacities, and otherwise absence of inciting causes of pulmonary eosinophilia (including asthma, atopic disease, or infection). Diagnosis of eosinophilic pneumonia is attained after meeting clinical criteria with a BAL sample demonstrating an eosinophilia differential of >25%. The mainstay of treatment for this condition is glucocorticoid therapy with most cases resolving rapidly after treatment. CONCLUSIONS: Fewer than 200 cases of acute eosinophilic pneumonia have been reported in medical literature. It is imperative to keep a wide differential as critical illness may be rapidly improved with appropriate therapy. The cause of acute eosinophilic pneumonia is largely unknown, it is unclear what role COVID-19 may have played in the development of this pneumonia. Reference #1: Allen J. Acute eosinophilic pneumonia. Semin Respir Crit Care Med. 2006 Apr;27(2):142-7. doi: 10.1055/s-2006-939517. PMID: 16612765. Reference #2: Nakagome K, Nagata M. Possible Mechanisms of Eosinophil Accumulation in Eosinophilic Pneumonia. Biomolecules. 2020 Apr 21;10(4):638. doi: 10.3390/biom10040638. PMID: 32326200;PMCID: PMC7226607. Reference #3: Yuzo Suzuki, Takafumi Suda, Eosinophilic pneumonia: A review of the previous literature, causes, diagnosis, and management, Allergology International, Volume 68, Issue 4, 2019, Pages 413-419, ISSN 1323-8930 DISCLOSURES: No relevant relationships by Tayler Acton No relevant relationships by Calli Bertschy No relevant relationships by Stewart Caskey No relevant relationships by Shekhar Ghamande No relevant relationships by Tyler Houston No relevant relationships by Zenia Sattar No relevant relationships by Heather Villarreal

PREVALENCE of FIBROMYALGIA in the RHEUMATOLOGY OPDS during COVID19 LOCKDOWN: A CROSS-SECTIONAL STUDY

Background: In the challenging times of Covid 19, anxiety increased among the general population. Fibromyalgia patients are more at risk of developing anxiety in these difficult times. This might result in more frequent visits to the rheumatology clinics with an exacerbation of their chronic pain syndrome. Objectives: The main objective of this study is to compare the prevalence of FM in the rheumatology outpatients' clinics during the Covid 19 lockdown period (2020) and during the same period in the previous year (2019). Methods: A cross-sectional study is conducted through 5 rheumatology clinics located in the 3 biggest emirates of the country (3 in Dubai, 1 in Abu Dhabi and 1 in Sharjah) to detect the number and charachteristics of fbromyalgia from March 15 to May 15th2019, and March 15 to May 15th2020. Results: Total number of patients seen from march to May 2019 was 3480 out of them 55 were fbromyalgia patients with frequency 0.0158%. While from march to May 2020 total number of patients seen were 1355 out of them 66 were fbromy-algia patients with frequency 0.0487%. Figure 1 Descriptive analysis of fibromyalgia patients seen in the lockdown time March to May 2020 shows that;gender was 64 females 97%, 2 males 3%, profession 36 unemployed 54.5%, 28 white collar 42.4%, 2 blue collar 3%, Age minimum was 25 years, maximum 77 years, with mean 48.3±13 years. Table 1 Tender points were 15.7±3, VAS for pain 6.5±2.1, sleep disturbance was present in 47 patients 71.2%, fatigue 65 patients 98.5%, irritable bowel syndrome in 26 patients 39.4%, headache in 32 patients 48.5%, anxiety in 43 patients 65.2%, and Depression in 37 patients 56.1 %. Comparing frequencies of fbromyalgia between March to May 2019 and 2020 shows a signifcantly higher frequency of fbromyalgia in March to May 2020, 3.1-fold more than 2019. Conclusion: The prevalence of patients with fbromyalgia seen in the Rheumatology clinics signifcantly increased during the lockdown time in comparison to the same period of 2019.

IMPACT OF ENVIRONMENTAL CHANGES FORCED BY PANDEMIC RESTRICTIVE MEASURES ON THE DEVELOPMENT AND COURSE OF IRRITABLE BOWEL SYNDROME

Background and aim: Irritable Bowel Syndrome (IBS) is a highly prevalent disorder that greatly affects patients’ quality of life, causing a significant burden to healthcare systems worldwide. Its pathophysiology is incompletely understood but symptoms seem to be the result of an interplay between environmental and patientrelated factors. This study aimed to analyse the influence of lockdown-forced changes in lifestyle habits and COVID-19 pandemic stress on the development of IBS manifestations. Materials and methods: An online survey was sent to groups of people representative of the general population. It contained questions regarding sociodemographic data, dietary habits, alcohol consumption, smoking habits, physical activity, sleeping hours, working activities, stress level and GI symptoms, related to both the pre-pandemic and lockdown period. A P-value<0.05 was considered statistically significant. Uni and Multivariate Cox methods and Wald test were used to evaluate the association between exposure variables and IBS occurrence/resolution. Results: From April 1st to 30th, 2020, 2735 participants completed the survey(mean age:39.7±16.1 years, F:M=2:1). During lockdown 122 IBS patients (46.2%) reported improvement of symptoms while 118 negative subjects (4.8%) developed IBS. Age,gender,BMI,employ ment,teleworking and smoking were not associated with IBS incidence or resolution. Reduced general stress(OR=2.23,95%CI 1.09- 4.56,P=0.029), increased fibers intake(OR=2.83,95%CI 1.60- 5.02,P<0.001) and increased hours of sleep(OR=2.00,95%CI 1.07-3.76,P=0.031) were associated with a high probability of resolution of IBS, while increased intake of anxiolytic pills(OR=0.14,95%CI 0.04-0.46,P=0.001) showed a low probability of resolution of IBS. Reduced physical activity(OR=2.04,95%CI 1.30-3.19,P=0.002), increased anti-inflammatory (OR=2.38,95%CI 1.39-4.10,P=0.002), anxiolytic pills intake(OR=3.52,95%CI 2.08-5.95,P<0.001) and increased work related stress(OR=1.81,95%CI 1.16-2.83,P=0.009) were risk factors for IBS occurrence. Finally, the resolution of IBS did not affect the onset of upper GI functional symptoms(OR=0.18,95%CI 0.11-0.31,P<0.001). (Figure Presented) Conclusions: Lifestyle changes forced by COVID-19 lockdown resulted in a beneficial effect in almost half of IBS patients, whereas they favoured the development of IBS in 5% of healthy subjects, thus confirming that environmental factors play a pivotal role in the pathophysiology of IBS. In particular, stress, fibres and alcohol intake seem to be able to influence IBS occurrence or resolution.

Highlights

Cell Resistance to Ebola and Coronaviruses

The possible role of viruses in the development of irritable bowel syndrome

Background: Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder characterized by abdominal pain and changes in intestinal movements in the absence of structural or biochemical abnormalities. In spite of the high prevalence its etiology is unknown and there are no specific diagnostic laboratory tests. Material and Methods: In a case/control study, 36 biopsy samples taken from of irritable bowel syndrome patients and 30 biopsy samples as control were obtained. expression of TLR 3, TLR 9 and RIG 1 in Macrophages, Lymphocytes and Plasma cells in terms of percentage and color intensity were evaluated by Immunohistochemistry. The obtained data were statistically analyzed using Mann Whitney u, chi-square methods.

PREVALENCE OF PEDIATRIC FUNCTIONAL GASTROINTESTINAL DISORDERS UTILIZING THE ROME IV CRITERIA IN 3 LATIN AMERICAN COUNTRIES

INTRODUCTION: According to ROMA IV (R-IV), in schoolchildren and adolescents in Colombia and Ecuador, the prevalence to present some functional gastrointestinal disorder (FGID) is 21.2%-22.3% being the main FGID the functional constipation (FC). There’s no data about infants and toddlers in latinoamerican countries (Latam). OBJECTIVE: To describe the prevalence of FGIDs in children in 3 Latam countries according to R-IV. METHODS: 11493 children in Colombia, Ecuador and Panama were included: 1382 infants aged 0-12 months (Group A, 7.3+/-3.7 months), 2631 toddlers aged 1-4 years (Group B, 2.5+/-0.9 years old), 2791 schoolchildren aged 8-12 years (Group C, 10.6+/-1.2 years) and 4689 adolescents aged 13-18 years (Group D, 14.8+/-1.4 years). FGIDs were identified through the Questionnaire of Pediatric Gastrointestinal Symptoms Rome IV (QPGS-IV). RESULTS: The prevalence to present some FGID was 15.8% in infants;23.3% in toddlers;21.1% in schoolchildren and 22.1% in adolescents;being the most frequent FGDI in the Group A, colic (7.6%), regurgitation (6.4%) and FC (4.7%);in the Group B, FC (17.6%), cyclic vomiting syndrome (5.4%) and functional diarrhea (0.3%);in the Group C, FC (12.5%), functional dyspepsia (2.8%) and irritable bowel syndrome (1.8%), and the Group D, FC (11.1%), functional dyspepsia (3.9%) and functional abdominal pain (1.9%). There were more FGDIs in infants with caesarean section (OR=1.7 95%CI=1.22-2.41 p=0.0010), toddlers with previous diarrhea (OR=1.7 95% CI=1.39-2.23 p=0.0000), in schoolchildren with previous dengue infection (OR=2.0 95%CI=1.24-3.25 p=0.0019) and adolescents in covid-19 confinement (OR=1.4 95%CI =1.13-1.78 p=0.0013). CONCLUSIONS: The prevalence for FGIDs was lower in infants whose main FGDI was colic;the FC was one of the main FGIDs in all the age groups, being associated in children younger than 4 years old to caesarean section and history of diarrhea and children between 8-18 years old to history of dengue and confinement.

PATIENT PERSPECTIVES ON REMOTE HYPNOTHERAPY FOR IRRITABLE BOWEL SYNDROME DURING THE COVID-19 PANDEMIC: THE 'NEW NORM’ OR JUST A TEMPORARY SOLUTION?

Introduction Gut-directed hypnotherapy is an evidence-based treatment for refractory Irritable Bowel Syndrome (IBS). Traditionally, hypnotherapy has been delivered face-to-face, but the emergence of video-technology has enabled remote delivery with comparable results1. However, data on patient experience and acceptance of remote hypnotherapy for IBS are lacking. We therefore evaluated feedback from consecutive patients that received remote hypnotherapy during enforced COVID-19 restrictions. Methods Patients with refractory IBS referred for hypnotherapy at a tertiary centre received 12-sessions of hypnotherapy remotely via Skype using the Manchester Protocol2 during COVID-19 restrictions. As part of a service evaluation, consecutive patients treated during the COVID-19 pandemic completed a 14- item feedback questionnaire on their experience and opinions following their course of remote gut-directed hypnotherapy. Results 29 patients with refractory IBS (22/29 (76%) female, 15/29 (52%) aged >41-years) completed the feedback questionnaire after receiving remote hypnotherapy during the pandemic. Overall,16/29 (55%) of patients indicated that they would have opted for remote over face-to-face hypnotherapy regardless of the pandemic situation. These preferences did not differ between those who were local, and those based >20 miles distance from the treatment centre (P=0.84). Most rated the video-technology (Skype) easy to use (25/29, 86%). The majority (25/29, 86%) reported that remote hypnotherapy improved their global IBS symptoms, with 16/29 (55%) reporting >30% overall improvement, and 6/29 (21%) reporting >50% improvement. Remote hypnotherapy also improved stress levels (26/29, 90%) and quality-of-life (24/29, 83%). However, after completing remote treatment, 15/29 (52%) felt they would have had more benefit from face-to-face hypnotherapy. The main advantages of remote hypnotherapy from a patient perspective were improved access (21/29,72%);reduced travel costs (23/29,79%) and convenience (21/ 29,72%). The main difficulties frequently encountered included: in-home interruptions (9/ 29,31%);issues with internet connectivity (9/29,31%) and difficulties logging in (9/29, 31%). However, the majority (25/29, 86%) would recommend remote hypnotherapy to a friend/relative with similar symptoms. Conclusion Remote gut-directed hypnotherapy for IBS has been well received by patients and has been effective in providing effective treatment during enforced pandemic restrictions. In the post-COVID era, these data support the need to continue to develop and optimise remote hypnotherapy, but also suggest that there may still be a role for face-to-face hypnotherapy, with patient choice being an important factor.

THE IMPACT OF IBS ON SELF-REPORTED PHYSICAL AND MENTAL HEALTH DURING THE COVID PANDEMIC – A NORWEGIAN TWIN STUDY

Background: Irritable bowel syndrome (IBS) is a stress-sensitive gut-brain disorder. The outbreak of Covid-19 has influenced the level of stress and anxiety at least for some people. Individuals with IBS often report poor self-rated health (SRH), which also reflects psychological and social aspects of life and an overall sense of well-being. This populationbased twin study evaluates whether the Covid pandemic has affected self-reports of abdominal symptoms of IBS and ratings of physical (p_SRH) and mental health (m_SRH) among individuals with IBS. Further, we calculate measures of twin similarity and correlations across traits to gain insights into the importance of genetic influences. Methods: In July 2021, we invited 17138 twins from the Norwegian Twin Register to complete a questionnaire asking how the pandemic affected their health and well-being, including depression, perceived stress, loneliness, anxiety, chronic somatic and pain-related diseases. Responses were received from 9032 twins, aged 19 – 86 of whom 831 reported a positive history of IBS (Table 1). Hierarchical regression models were used to estimate the impact of IBS on p_ SRH and m_SRH during the Covid pandemic, covariates in the stepwise modeling included age, sex, education, and other chronic physical and mental health conditions. Phenotypic, intraclass and cross-twin cross-trait correlations were computed for IBS and the health measures. Results: The majority of individuals with IBS reported no changes in abdominal pain or bowel disturbance during the pandemic. Nonetheless, they did report worse perceptions of health compared to those without IBS. Further findings revealed weak but significant associations between IBS and changes in perceived stress. Age was inversely related to ratings for p_SRH and m_SRH, with younger participants reporting that their mental and physical health worsened more than older participants. IBS retained significance as a predictor of worsening m_SRH after accounting for depression and perceived stress (model 5, Table 2) [OR = 1.22 (1.00;1.50), Table 2]. The intraclass correlations for worse p_SRH and m_SRH were greater among monozygotic (MZ) than dizygotic (DZ) twins, which is consistent with genetic variance explaining some of the differences in how the pandemic has affected perceptions of health. Cross-twin cross-trait correlations between IBS and worse p_SRH were 0.15 (0.11;0.18) for MZ twins and 0.08 (0.03;0.12) for DZ twins, suggesting that common genetic factors may underlie this relationship Conclusion: Abdominal symptoms of IBS did not change during the pandemic. However, IBS was predictive of worsening of mental SRH, not confounded by depression or perceived stress. These results underscore the role of psychosocial and emotional factors for mental health in IBS during the pandemic. (Table Presented) (Table Presented) (Table Presented) (Table Presented)

POST-COVID-19 DISORDERS OF GUT-BRAIN INTERACTION (DGBI): AN INTERNET-BASED EPIDEMIOLOGICAL STUDY

Background: Post-COVID-19 conditions are defined as new, recurring, or ongoing health issues which present weeks after SARS-CoV-2 infection. The gastrointestinal (GI) involvement of COVID-19 suggests that a group of patients with lingering GI symptoms may develop Post-COVID-19 DGBI including irritable bowel syndrome (IBS) (Schmulson M et al. Am J Gastroenterol. 2021;116:4-7). In this study, we aimed to determine the epidemiological features of Post-COVID-19 DGBI. Methods: Subjects with confirmed COVID-19 at least 6 months before the study who had sustained GI symptoms were invited to complete an internet-based survey on Qualtrics, between March and August 2021. The survey included demographics, acute symptoms, comorbidities, as well as Rome IV questionnaire, Generalized Anxiety Disorder questionnaire (GAD-7) and Patient Health Questionnaire (PHQ)-9 for depression. Data was analyzed using ANOVA and multivariate analysis. Findings were reported as percentage or [p-value;(95% odds ratio CI)]. Results: Overall, 164 subjects (70% female, 14% male, and others unknown) with a positive COVID-19 test completed the survey. Among them, 4% were >65 years old and 24% reported hospitalization. Body mass index ³30 was present in 38%, diabetes in 6.7%, and vitamin D deficiency in 11% of the participants. In total, 108 (66%) subjects fulfilled Rome IV criteria for at least one DGBI. Of 108 with DGBI, only 27 (25%) had DGBI before COVID-19;DGBI developed in 81 subjects after COVID-19. The most common Post-COVID-19 DGBI were functional dyspepsia observed in 38 (postprandial distress syndrome n=31, epigastric pain syndrome n=22) followed by IBS in 26 subjects (IBS with Diarrhea n=7, IBS with Constipation n=4, Mixed-IBS n=14, Unsubtyped IBS n=1) (Table-1). The risk factors of severe COVID-19 including age >65, diabetes, and obesity were not associated with developing Post-COVID- 19 DGBI. Seventy (86%) of subjects with Post-COVID-19 DGBI had at least one GI symptom (abdominal pain, nausea/vomiting, and/or diarrhea) in the acute phase of COVID-19. Nausea/ vomiting during the acute illness increased [p-value of 0.02 with 95% OR CI (0.7-10.4)], and BMI less than 25 also increased the odds [p-value of 0.03 (95% OR CI: 0.26-8.4)] for Post-COVID-19 IBS. Anxiety was present in 48% and depression in 65% of subjects with Post-COVID-19 DGBI. Conclusions: Post-COVID-19 DGBI are new entities associated with a high rate of anxiety and depression. Although the majority of those with Post-COVID-19 DGBI reported having GI symptoms in the acute illness, some appeared in subjects without acute GI symptoms. (Table Presented)

COVID-19 EXACERBATES EXISTING DIGESTIVE DISORDERS AND TRIGGERS NEW DIGESTIVE SYMPTOMS AND DIAGNOSES: RESULTS FROM AN INTERNATIONAL PATIENT SURVEY

Background/Aims: COVID-19 infection can affect nearly every organ system including the gastrointestinal (GI) tract. GI symptoms such as nausea, pain and diarrhea are common and may be due to infection and/or increased stress and isolation from the pandemic. It is well known that stress affects GI function and sensation, particularly in patients with irritable bowel syndrome (IBS). The aim of the study was to elucidate the impact of the COVID-19 pandemic on GI symptoms. Methods: An international online survey (Alchemer) was available via the International Foundation of GI Disorders (IFFGD) website from August 11, 2021- November 17, 2021. There were 57 questions exploring demographics, GI symptom/disorder classification, care delivery, administration and perceptions of COVID-19 vaccination, and health experiences during the pandemic. No compensation was provided for survey completion and patients were able to selectively answer questions, with some questions not analyzed for this report. Results: Survey data was included from 210 patients with GI symptoms (mean age 47.7 yrs, 83% female, 80% Caucasian). Participants' primary GI conditions included 36% IBS, 26% gastroparesis, 6% constipation, and 9% acid reflux (figure 1). Seventy percent reported the pandemic impacted their GI health and nearly 3 out of 4 (73%) reported increased pandemic-related anxiety or depression. COVID-19 was diagnosed in 40 (19%) participants. Nearly 3 out of 4 (74%) experienced new or worsening GI symptoms after a COVID-19 diagnosis. Almost a third (30%) with COVID-19 were diagnosed with post-infection (PI) IBS and 38% were diagnosed with a new GI disorder other than PI-IBS. New GI diagnoses after COVID-19 included gastroparesis (53%), GERD (13%), and diarrhea (7%) (figure 2). Prior to diagnosis of PI-IBS, 58% did not have a GI diagnosis. Almost half (46%) of patients reported new acid reflux symptoms after COVID-19. Almost 3 out of 4 patients (72%) with COVID-19 noticed changes in digestion and/or bowel movements. More than two thirds (67%) noted COVID-related GI symptoms lasted >3 months. Nearly 3 out of 4 (72%) patients felt their GI symptoms were harder to manage after COVID-19. Conclusions: Our results highlight the significant burden of GI illness imposed by the COVID-19 pandemic. COVID-19 exacerbated existing GI conditions, increased anxiety and depression, and led to a wide range of new GI issues, led by but not limited to PI-IBS. New diagnoses of upper GI disorders including gastroparesis and GERD were surprisingly common. Further prospective studies to validate these observations and understand their pathogenesis are warranted. (Figure Presented) Figure 1: Participants primary gastrointestinal condition or disorder prior to the COVID- 19 pandemic. (Figure Presented) Figure 2: New GI disorders diagnosed after being diagnosed with COVID-19