Opinion Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
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.

Keywords: SARS-CoV-2; COVID-19; Irritable bowel syndrome; Microbiota; Dysbiosis; Gut-brain axis

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.