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

ABSTRACT

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 age39.7±16.1 years, FM=21). 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.