A Gut-Wrenching Pandemic for Patients With Functional GI Issues

Patients with irritable bowel syndrome (IBS), gastroparesis, or functional dyspepsia had more gastrointestinal symptoms during the pandemic, a retrospective single-center study found.

Compared to the 6 months before the pandemic, more patients with common functional gastrointestinal and motility disorders (FGIMD) experienced symptoms during the pandemic, including nausea or vomiting (16% vs 22%, respectively), constipation (13% vs 17%), and abdominal pain (23% vs 30%, P<0.0001 for all), reported John Gubatan, MD, from Stanford University School of Medicine in California, and colleagues.

These patients also experienced more diarrhea (10% vs 13%, P<0.0001) and weight loss (4.3% vs 5.8%, P=0.01), the authors wrote in Neurogastroenterology & Motility.

Gubatan told MedPage Today that the increases in gastrointestinal symptoms for this group “was not directly linked with having COVID-19, suggesting other factors may be at play — anxiety/stress from pandemic, lifestyle changes imposed by stay-at-home orders, etc.”

“We expected healthcare utilization to decrease given healthcare access disruption during the COVID-19 pandemic, but had the opposite findings,” he added.

Outpatient healthcare visits among the 2,509 FGIMD patients who tested negative for SARS-CoV-2 increased compared with the 6 months before the pandemic (5.68 vs 4.78 visits per patient, respectively, P<0.0001), as did hospitalizations (0.50 vs 0.36 per patient, P<0.0001), colonoscopies (0.10 vs 0.04, P<0.0001), and CT imaging (0.23 vs 0.18, P=0.002), the authors said.

Given that pre-pandemic FGIMD-related healthcare use was high and gastrointestinal symptoms can manifest in COVID-19, researchers assessed the frequency of healthcare use and clinical implications among FGIMD patients affected by the pandemic.

They analyzed data from 2,592 participants with FGIMD who were tested for SARS-CoV-2 and received emergency department, inpatient or outpatient care at Stanford University health facilities from March 2020 to September 2020. They also evaluated data 6 months prior (September 2019 to March 2020). Both asymptomatic and symptomatic patients were included and given symptom reporting questionnaires.

The primary outcome was gastrointestinal symptom changes, medication and healthcare use prior to and during the pandemic, and they evaluated three FGIMD disorders: gastroparesis, functional dyspepsia, and IBS.

Mean patient age was 52, about 58% were white, and 79% were women. About 61% of patients had a past medical history of IBS, 29% reported a prior history of gastroparesis, and 46% reported functional dyspepsia.

The prevalence of COVID-19 infections in the FGIMD cohort was 3.2% (83 patients). Multiple regression analyses showed independent risk factors for COVID-19 included IBS-diarrhea predominant (OR 2.37, 95% CI 1.34-4.19) and smoking (OR 3.13, 95% CI 1.38-7.09). However, current alcohol use (OR 0.26, 95% CI 0.15-0.44) and functional dyspepsia (OR 0.46, 95% CI 0.27-0.79) were tied to decreased risk of COVID-19.

FGIMD patients who tested negative for COVID-19 also reported a higher rate of opioid and H2 blocker use during the pandemic versus 6 months before. Interestingly, the authors found that proton pump inhibitor (PPI) use was only higher in patients with functional dyspepsia.

“Our study does not support avoiding PPIs in patients with FGIMD to decrease risk of COVID-19 if they are clinically indicated,” Gubatan said. “It would be interesting to see if the trends in this study (increased GI symptoms, med use, and healthcare utilization) changed in 2021 as the COVID-19 pandemic improved.”

Study limitations included the single-center observational design, the potential for underestimating medication use, as well as limited generalizability, as most findings apply to only FGIMD patients who tested negative for COVID-19, the authors acknowledged. Use of ICD codes could also introduce potential selection bias and misclassification, they added.