STUDYING SOME POSSIBLE IRRITABLE BOWEL SYNDROME MANIFESTATIONS IN COVID-19 PATIENTS
Abstract
The starting point of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic is a highly debated topic today. Despite the fact that a multitude of hypotheses have been issued in this context, this new strain beta-coronavirus is not only highly contagious, but also rapidly transmitted interpersonally through the perpetually disrupting the homeostasis. It constantly affects the lungs, and also the digestive tract according to the latest reports following its binding to the angiotensin-converting enzyme 2 (ACE2) receptors. Material and methods: In the present study we aimed to explain and describe some gastrointestinal deficiencies exhibited by the positive patients Therefore, the Visual Analogue Scale-IBS (VAS-IBS) questionnaire was applied to a group of positive patients (n = 22) and compared to their sex-matched controls (n = 22). The confirmation for the SARS-CoV-2 infection was carried out by specific RT-qPCR testing. Results: We observed that the overall scores attributed to the spectrum of Physical symptoms, Mental health and Quality of life are significantly different among the COVID-19 group dependent on sex than in the control group. However, we did not find significant differences in terms of shape and stool consistencies (as evaluated by Bristol scale). Conclusions: In this study, we showed that several gastrointestinal symptoms (as evaluated by VAS-IBS scale) could occur during or following SARS-CoV-2 infection.
References
1. van der hoek L. Human coronaviruses: What do they cause? Antivir Ther 2007; 12: 651-658.
2. Lam WK, Zhong N, Tan W. Overview on SARS in Asia and the World. Respirology 2003; 8: S2-5.
3. Chen ZL, Zhang Q, Lu Y, Guo ZM, Zhang X, Zhang WJ. Distribution of the COVID-19 epidemic and correlation with population emigration from Wuhan, China. Chin Med J (Engl) 2020; 133: 1044-1050.
4. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z. Clinical course and risk factors for mortality of adult inpa-tients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395: 1054-1062.
5. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497-506.
6. Zhu N, Zhang D, Wang W, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med 2020; 382: 727-733.
7. Guan W, Ni Z, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020; 382: 1708-1720.
8. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395: 507-513.
9. Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020; 323: 1061-1069.
10. D’Amico F, Baumgart DC, Danese S, Peyrin-Biroulet L. Diarrhea During COVID-19 Infection: Pathogenesis, Epidemiology, Prevention, and Management. Clin Gastroenterol Hepatol 2020; 18: 1663-1672.
11. Zhou D, Dai SM, Tong Q. COVID-19: a recommendation to examine the effect of hydroxychloroquine in preventing infection and progression. J Antimicrob Chemother 2020; 75(7): 1667-1670.
12. Bescos R, Ashworth A, Cutler C, et al. Effects of Chlorhexidine mouthwash on the oral microbiome. Sci Rep 2020; 10: 5254 / doi: 10.1038/s41598-020-61912-4.
13. Giallonardo V, Sampogna G, Vecchio V, et al. The Impact of Quarantine and Physical Distancing Following COVID-19 on Mental Health: Study Protocol of a Multicentric Italian Population Trial. Front Psychiatry 2020; 11: 533 / doi: 10.3389/fpsyt.2020.00533.
14. Orgilés M, Morales A, Delvecchio E, Mazzeschi C, Espada J. Immediate psychological effects of the COVID-19 quarantine in youth from Italy and Spain. Front Psychol 2020; 11: 579038 / doi: 10.3389/ fpsyg. 2020. 579038.
15. Bengtsson M, Hammar O, Mandl T, Ohlsson B. Evaluation of gastrointestinal symptoms in different patient groups using the visual analogue scale for irritable bowel syndrome (VAS-IBS). BMC Gastro-enterol 2011; 11: 122 / doi: 10.1186/1471-230X-11-122.
16. Bengtsson M, Ohlsson B, Ulander K. Development and psychometric testing of the Visual Analogue Scale for Irritable Bowel Syndrome (VAS-IBS). BMC Gastroenterol 2007; 7: 16 / doi: 10.1186/1471-230X-7-16.
17. Vazquez Roque M, Bouras EP. Epidemiology and management of chronic constipation in elderly patients. Clin Interv Aging 2015; 10: 919-930.
18. Han C, Duan C, Zhang S, et al. Digestive Symptoms in COVID-19 Patients with Mild Disease Sever-ity: Clinical Presentation, Stool Viral RNA Testing, and Outcomes. Am J Gastroenterol 2020; 115: 916-923.
19. Hormati A, Shahhamzeh A, Afifian M, Khodadust F, Ahmadpour S. Can COVID-19 present unusual GI symptoms? J Microbiol Immunol Infect 2020; 53: 384-385.
20. Wang Z, Chen X, Lu Y, Chen F, Zhang W. Clinical characteristics and therapeutic procedure for four cases with 2019 novel coronavirus pneumonia receiving combined Chinese and Western medicine treatment. Biosci Trends 2020; 14: 64-68.
21. Jin X, Lian J-S, Hu J-H, et al. Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut 2020; 69: 1002 LP-1009.
22. Lin L, Jiang X, Zhang Z, Huang S, Zhang Z, Fang Z, et al. Gastrointestinal symptoms of 95 cases with SARS-CoV-2 infection. Gut 2020; 69: 997-1001.
23. Wu Y, Guo C, Tang L, et al. Prolonged presence of SARS-CoV-2 viral RNA in fecal samples. Lancet Gastroenterol Hepatol 2020; 5: 434-435.
24. Holshue ML, DeBolt C, Lindquist S, et al. First Case of 2019 Novel Coronavirus in the United States. N Engl J Med 2020; 382: 929-936.
25. Zheng S, Fan J, Yu F, et al. Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January-March 2020: retrospective cohort study. BMJ 2020; 369: m1443 / doi: 10.1136/bmj.m1443.
26. Xu X-W, Wu X-X, Jiang X-G, et al. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-CoV-2) outside of Wuhan, China: retrospective case series. BMJ 2020; 368: m606 / doi: 10.1136/bmj.m606.
27. Effenberger M, Grabherr F, Mayr L, et al. Fecal calprotectin indicates intestinal inflammation in COVID-19. Gut 2020; 69(8): 1543-1544.
28. Sriwijitalai W, Wiwanitkit V. COVID-19 in forensic medicine unit personnel: Observation from Thailand. J Forensic Leg Med 2020; 72: 101964 / doi: 10.1016/j.jflm.2020.101964.
29. Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for Gastrointestinal Infection of SARS-CoV-2. Gastroenterology 2020; 158: 1831-1833.
30. Mazza S, Sorce A, Peyvandi F, Vecchi M, Caprioli F. A fatal case of COVID-19 pneumonia occurring in a patient with severe acute ulcerative colitis. Gut 2020; 69: 1148-1149.
31. Taxonera C, Sagastagoitia I, Alba C, Mañas N, Olivares D, Rey E. 2019 novel coronavirus disease (COVID-19) in patients with inflammatory bowel diseases. Aliment Pharmacol Ther 2020; 52: 276-283.
32. Ono K, Kishimoto M, Shimasaki T, et al. Reactive arthritis after COVID-19 infection. RMD Open 2020; 6: e001350 / doi: 10.1136/rmdopen-2020-001350.
33. Toscano G, Palmerini F, Ravaglia S, et al. Guillain-Barré Syndrome Associated with SARS-CoV-2. N Engl J Med 2020; 382: 2574-2576.
34. Statescu C, Honceriu C, Trus C. Does Magnesium Deficient Diet and its Associated Metabolic Dys-functions Induces Anxiety-like Symptoms Further cardiovascular relevance. Revista de Chimie 2019; 70: 3579-3581.
35. Kinda P, Guenné S, Basile T, et al. Brain protection and anti-amnesic effects assessment of datura innoxia mill. aqueous extracts. Farmacia 2020, 68(2): 261-268.
36. Cojocariu R, Balmus IM, Lefter R, et al. Camelina sativa methanolic and ethanolic extracts potential in alleviating oxidative stress, memory deficits and affective impairments in stress exposure-based irritable bowel syndrome mice models. Oxidative Medicine and Cellular Longevity 2020: 9510305/ doi: 10.1155/2020/9510305
37. Cojocariu R, Balmus IM, Lefter R, et al. Behavioral and oxidative stress changes in mice subjected to combinations of multiple stressors relevant for irritable bowel syndrome. Brain Sciences 2020; 10(11): 865 / doi: 10.3390/brainsci10110865.
38. Massaoudi Y, Ciobica A, Dobrin I, Hassouni M. Halophilic bacteria - a potential therapeutical approach for autism? Romanian Biotechnological Letters 2019; 24: 826-836.
39. Balmus IM, Ciobica A, Cojocariu R, Luca AC, Gorgan L. Irritable Bowel Syndrome and the Neuro-logical Deficiencies: Is There A Relationship? The Possible Relevance of the Oxidative Stress Status. Medicina (Kaunas) 2020; 56(4): 175 / doi: 10.3390/medicina56040175.
40. Ilie OD, Ciobica A, McKenna J, Doroftei B, Mavroudis I. Mini-review on the relations between gut microflora and Parkinson’s disease-further biochemical (oxidative stress), inflammatory and neuro-logical particularities. Oxidative Medicine and Cellular Longevity 2020: 4518023 / doi: 10.1155/ 2020/4518023.
41. Prepelita R, Cristofor AC, Dobrin R, Trus C, Ciobica A, Chirita R. The Serotonin-Dopamine Rela-tionship on the Aggression-Suicidal Risk Axis in Patients with Major Depression Disorder: Describing Some Social Implications. Revista de Cercetare si Interventie Sociala 2019; 65: 111-130.
42. Dobrin I, Chirita R, Dobrin R, et al. Social Intervention as an Adjuvant Therapy for Patients with Schizophrenia. Revista de Cercetare si Interventie Sociala 2020; 68: 261-270.
43. Kunzler AM, Röthke N, Günthner L, et al. Mental burden and its risk and protective factors during the early phase of the SARS-CoV-2 pandemic: systematic review and meta-analyses. Global Health 2021; 17(1): 34 / doi: 10.1186/s12992-021-00670-y.
44. Adorjan K, Haussmann R, Rauen K, Pogarell O. Folgen der COVID-19-Pandemie für Menschen mit Schizophrenie, Demenz und Abhängigkeitserkrankungen. Nervenarzt 2021; 92(6): 571-578.
45. Mensi MM, Capone L, Rogantini C, Orlandi M, Ballante E, Borgatti R. COVID-19-related psychiatric impact on Italian adolescent population: A cross-sectional cohort study. J Community Psychol 2021 / doi: 10.1002/jcop.22563.
46. Hawton K, Lascelles K, Brand F, et al. Self-harm and the COVID-19 pandemic: A study of factors contributing to self-harm during lockdown restrictions. J Psychiatr Res 2021; 137: 437-443.
47. Rezaei N, Grandner MA. Changes in sleep duration, timing, and variability during the COVID-19 pandemic: Large-scale Fitbit data from 6 major US cities. Sleep Health 2021: S2352-7218(21)00029-2.
48. Cardenas J, Roach J, Kopelowicz A. Prevalence of COVID-19 Positive Cases Presenting to a Psychi-atric Emergency Room. Community Ment Health J 2021 1-4 / doi: 10.1007/s10597-021-00816-7.
49. Chen CY, Chen IH, Hou WL, et al. The Relationship Between Children’s Problematic Internet-related Behaviors and Psychological Distress During the Onset of the COVID-19 Pandemic: A Longitudinal Study. J Addict Med 2021 / doi: 10.1097/ADM. 0000000000000845.
2. Lam WK, Zhong N, Tan W. Overview on SARS in Asia and the World. Respirology 2003; 8: S2-5.
3. Chen ZL, Zhang Q, Lu Y, Guo ZM, Zhang X, Zhang WJ. Distribution of the COVID-19 epidemic and correlation with population emigration from Wuhan, China. Chin Med J (Engl) 2020; 133: 1044-1050.
4. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z. Clinical course and risk factors for mortality of adult inpa-tients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395: 1054-1062.
5. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497-506.
6. Zhu N, Zhang D, Wang W, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med 2020; 382: 727-733.
7. Guan W, Ni Z, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020; 382: 1708-1720.
8. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395: 507-513.
9. Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020; 323: 1061-1069.
10. D’Amico F, Baumgart DC, Danese S, Peyrin-Biroulet L. Diarrhea During COVID-19 Infection: Pathogenesis, Epidemiology, Prevention, and Management. Clin Gastroenterol Hepatol 2020; 18: 1663-1672.
11. Zhou D, Dai SM, Tong Q. COVID-19: a recommendation to examine the effect of hydroxychloroquine in preventing infection and progression. J Antimicrob Chemother 2020; 75(7): 1667-1670.
12. Bescos R, Ashworth A, Cutler C, et al. Effects of Chlorhexidine mouthwash on the oral microbiome. Sci Rep 2020; 10: 5254 / doi: 10.1038/s41598-020-61912-4.
13. Giallonardo V, Sampogna G, Vecchio V, et al. The Impact of Quarantine and Physical Distancing Following COVID-19 on Mental Health: Study Protocol of a Multicentric Italian Population Trial. Front Psychiatry 2020; 11: 533 / doi: 10.3389/fpsyt.2020.00533.
14. Orgilés M, Morales A, Delvecchio E, Mazzeschi C, Espada J. Immediate psychological effects of the COVID-19 quarantine in youth from Italy and Spain. Front Psychol 2020; 11: 579038 / doi: 10.3389/ fpsyg. 2020. 579038.
15. Bengtsson M, Hammar O, Mandl T, Ohlsson B. Evaluation of gastrointestinal symptoms in different patient groups using the visual analogue scale for irritable bowel syndrome (VAS-IBS). BMC Gastro-enterol 2011; 11: 122 / doi: 10.1186/1471-230X-11-122.
16. Bengtsson M, Ohlsson B, Ulander K. Development and psychometric testing of the Visual Analogue Scale for Irritable Bowel Syndrome (VAS-IBS). BMC Gastroenterol 2007; 7: 16 / doi: 10.1186/1471-230X-7-16.
17. Vazquez Roque M, Bouras EP. Epidemiology and management of chronic constipation in elderly patients. Clin Interv Aging 2015; 10: 919-930.
18. Han C, Duan C, Zhang S, et al. Digestive Symptoms in COVID-19 Patients with Mild Disease Sever-ity: Clinical Presentation, Stool Viral RNA Testing, and Outcomes. Am J Gastroenterol 2020; 115: 916-923.
19. Hormati A, Shahhamzeh A, Afifian M, Khodadust F, Ahmadpour S. Can COVID-19 present unusual GI symptoms? J Microbiol Immunol Infect 2020; 53: 384-385.
20. Wang Z, Chen X, Lu Y, Chen F, Zhang W. Clinical characteristics and therapeutic procedure for four cases with 2019 novel coronavirus pneumonia receiving combined Chinese and Western medicine treatment. Biosci Trends 2020; 14: 64-68.
21. Jin X, Lian J-S, Hu J-H, et al. Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut 2020; 69: 1002 LP-1009.
22. Lin L, Jiang X, Zhang Z, Huang S, Zhang Z, Fang Z, et al. Gastrointestinal symptoms of 95 cases with SARS-CoV-2 infection. Gut 2020; 69: 997-1001.
23. Wu Y, Guo C, Tang L, et al. Prolonged presence of SARS-CoV-2 viral RNA in fecal samples. Lancet Gastroenterol Hepatol 2020; 5: 434-435.
24. Holshue ML, DeBolt C, Lindquist S, et al. First Case of 2019 Novel Coronavirus in the United States. N Engl J Med 2020; 382: 929-936.
25. Zheng S, Fan J, Yu F, et al. Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January-March 2020: retrospective cohort study. BMJ 2020; 369: m1443 / doi: 10.1136/bmj.m1443.
26. Xu X-W, Wu X-X, Jiang X-G, et al. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-CoV-2) outside of Wuhan, China: retrospective case series. BMJ 2020; 368: m606 / doi: 10.1136/bmj.m606.
27. Effenberger M, Grabherr F, Mayr L, et al. Fecal calprotectin indicates intestinal inflammation in COVID-19. Gut 2020; 69(8): 1543-1544.
28. Sriwijitalai W, Wiwanitkit V. COVID-19 in forensic medicine unit personnel: Observation from Thailand. J Forensic Leg Med 2020; 72: 101964 / doi: 10.1016/j.jflm.2020.101964.
29. Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for Gastrointestinal Infection of SARS-CoV-2. Gastroenterology 2020; 158: 1831-1833.
30. Mazza S, Sorce A, Peyvandi F, Vecchi M, Caprioli F. A fatal case of COVID-19 pneumonia occurring in a patient with severe acute ulcerative colitis. Gut 2020; 69: 1148-1149.
31. Taxonera C, Sagastagoitia I, Alba C, Mañas N, Olivares D, Rey E. 2019 novel coronavirus disease (COVID-19) in patients with inflammatory bowel diseases. Aliment Pharmacol Ther 2020; 52: 276-283.
32. Ono K, Kishimoto M, Shimasaki T, et al. Reactive arthritis after COVID-19 infection. RMD Open 2020; 6: e001350 / doi: 10.1136/rmdopen-2020-001350.
33. Toscano G, Palmerini F, Ravaglia S, et al. Guillain-Barré Syndrome Associated with SARS-CoV-2. N Engl J Med 2020; 382: 2574-2576.
34. Statescu C, Honceriu C, Trus C. Does Magnesium Deficient Diet and its Associated Metabolic Dys-functions Induces Anxiety-like Symptoms Further cardiovascular relevance. Revista de Chimie 2019; 70: 3579-3581.
35. Kinda P, Guenné S, Basile T, et al. Brain protection and anti-amnesic effects assessment of datura innoxia mill. aqueous extracts. Farmacia 2020, 68(2): 261-268.
36. Cojocariu R, Balmus IM, Lefter R, et al. Camelina sativa methanolic and ethanolic extracts potential in alleviating oxidative stress, memory deficits and affective impairments in stress exposure-based irritable bowel syndrome mice models. Oxidative Medicine and Cellular Longevity 2020: 9510305/ doi: 10.1155/2020/9510305
37. Cojocariu R, Balmus IM, Lefter R, et al. Behavioral and oxidative stress changes in mice subjected to combinations of multiple stressors relevant for irritable bowel syndrome. Brain Sciences 2020; 10(11): 865 / doi: 10.3390/brainsci10110865.
38. Massaoudi Y, Ciobica A, Dobrin I, Hassouni M. Halophilic bacteria - a potential therapeutical approach for autism? Romanian Biotechnological Letters 2019; 24: 826-836.
39. Balmus IM, Ciobica A, Cojocariu R, Luca AC, Gorgan L. Irritable Bowel Syndrome and the Neuro-logical Deficiencies: Is There A Relationship? The Possible Relevance of the Oxidative Stress Status. Medicina (Kaunas) 2020; 56(4): 175 / doi: 10.3390/medicina56040175.
40. Ilie OD, Ciobica A, McKenna J, Doroftei B, Mavroudis I. Mini-review on the relations between gut microflora and Parkinson’s disease-further biochemical (oxidative stress), inflammatory and neuro-logical particularities. Oxidative Medicine and Cellular Longevity 2020: 4518023 / doi: 10.1155/ 2020/4518023.
41. Prepelita R, Cristofor AC, Dobrin R, Trus C, Ciobica A, Chirita R. The Serotonin-Dopamine Rela-tionship on the Aggression-Suicidal Risk Axis in Patients with Major Depression Disorder: Describing Some Social Implications. Revista de Cercetare si Interventie Sociala 2019; 65: 111-130.
42. Dobrin I, Chirita R, Dobrin R, et al. Social Intervention as an Adjuvant Therapy for Patients with Schizophrenia. Revista de Cercetare si Interventie Sociala 2020; 68: 261-270.
43. Kunzler AM, Röthke N, Günthner L, et al. Mental burden and its risk and protective factors during the early phase of the SARS-CoV-2 pandemic: systematic review and meta-analyses. Global Health 2021; 17(1): 34 / doi: 10.1186/s12992-021-00670-y.
44. Adorjan K, Haussmann R, Rauen K, Pogarell O. Folgen der COVID-19-Pandemie für Menschen mit Schizophrenie, Demenz und Abhängigkeitserkrankungen. Nervenarzt 2021; 92(6): 571-578.
45. Mensi MM, Capone L, Rogantini C, Orlandi M, Ballante E, Borgatti R. COVID-19-related psychiatric impact on Italian adolescent population: A cross-sectional cohort study. J Community Psychol 2021 / doi: 10.1002/jcop.22563.
46. Hawton K, Lascelles K, Brand F, et al. Self-harm and the COVID-19 pandemic: A study of factors contributing to self-harm during lockdown restrictions. J Psychiatr Res 2021; 137: 437-443.
47. Rezaei N, Grandner MA. Changes in sleep duration, timing, and variability during the COVID-19 pandemic: Large-scale Fitbit data from 6 major US cities. Sleep Health 2021: S2352-7218(21)00029-2.
48. Cardenas J, Roach J, Kopelowicz A. Prevalence of COVID-19 Positive Cases Presenting to a Psychi-atric Emergency Room. Community Ment Health J 2021 1-4 / doi: 10.1007/s10597-021-00816-7.
49. Chen CY, Chen IH, Hou WL, et al. The Relationship Between Children’s Problematic Internet-related Behaviors and Psychological Distress During the Onset of the COVID-19 Pandemic: A Longitudinal Study. J Addict Med 2021 / doi: 10.1097/ADM. 0000000000000845.
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