Settanni CR, Ianiro G, Ponziani FR, Bibbò S, Segal JP, Cammarota G, Gasbarrini A. COVID-19 as a trigger of irritable bowel syndrome: A review of potential mechanisms. World J Gastroenterol 2021; 27(43): 7433-7445 [PMID: 34887641 DOI: 10.3748/wjg.v27.i43.7433]
Corresponding Author of This Article
Carlo Romano Settanni, MD, Associate Specialist, Unità Operativa Complessa Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, Rome 00168, Italy. carloromano.settanni@guest.policlinicogemelli.it
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Opinion Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Nov 21, 2021; 27(43): 7433-7445 Published online Nov 21, 2021. doi: 10.3748/wjg.v27.i43.7433
COVID-19 as a trigger of irritable bowel syndrome: A review of potential mechanisms
Carlo Romano Settanni, Gianluca Ianiro, Francesca Romana Ponziani, Stefano Bibbò, Jonathan Philip Segal, Giovanni Cammarota, Antonio Gasbarrini
Carlo Romano Settanni, Gianluca Ianiro, Francesca Romana Ponziani, Stefano Bibbò, Giovanni Cammarota, Antonio Gasbarrini, Unità Operativa Complessa Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome 00168, Italy
Carlo Romano Settanni, Gianluca Ianiro, Francesca Romana Ponziani, Stefano Bibbò, Giovanni Cammarota, Antonio Gasbarrini, Istituto di Patologia Speciale Medica, Università Cattolica del Sacro Cuore, Rome 00168, Italy
Jonathan Philip Segal, Department of Gastroenterology and Hepatology, Hillingdon Hospital, Uxbridge HA1 3UJ, United Kingdom
Author contributions: Gasbarrini A and Cammarota G conceived the idea for the manuscript, suggested the topics, provided the setting of the paper and supervised the entire work; Bibbò S wrote the introduction; Ponziani FR summarised the current literature about the gastrointestinal involvement of COVID-19; Ianiro G wrote the irritable bowel syndrome (IBS) section; Settanni CR analysed the hypothetical COVID-19 related factors which can promote the development of IBS and drew the conclusion; Segal JP revised the whole manuscript.
Conflict-of-interest statement: The authors declare no conflict of interests.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Carlo Romano Settanni, MD, Associate Specialist, Unità Operativa Complessa Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, Rome 00168, Italy. carloromano.settanni@guest.policlinicogemelli.it
Received: March 4, 2021 Peer-review started: March 4, 2021 First decision: May 5, 2021 Revised: May 10, 2021 Accepted: November 15, 2021 Article in press: November 15, 2021 Published online: November 21, 2021 Processing time: 260 Days and 2.7 Hours
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.
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.
