OTH-2 The symptom burden of irritable bowel syndrome in tertiary care during the Covid-19 pandemic

Abstract

IntroductionRecent data on the natural history of Irritable Bowel Syndrome (IBS) highlight the prognostic importance of extra-intestinal and psychological symptom profiles. Those with a high psychological burden have been shown to have the worst prognosis, and are consequently most likely to be referred to tertiary care. The Covid-19 pandemic caused significant disruption to tertiary services and affected the mental health of the nation, however there is minimal data on the effects on patients with IBS in tertiary care. We therefore compared the symptom profiles of tertiary referrals with refractory IBS, 12-months before, and 12-months after the onset of Covid-19 restrictions in the UK.MethodsAs part of their routine care, all patients with refractory IBS referred to the tertiary service before and after the Covid-19 pandemic prospectively completed a series of questionnaires during their baseline consultation including;IBS symptom severity score (IBS-SSS), non-colonic symptom score, Hospital Anxiety and Depression (HAD), and Quality of Life (QoL). Demographic data and symptom profiles were compared between patients seen in the 12 months before the pandemic (22/03/2019 - 22/03/2020) with those seen in the 12-months after (23/03/2020 - 23/03/2021), using non-parametric tests.ResultsOverall, 190 patients (median age 43 years, n=157 (82.6%) female, 41.0% IBS-C, 24.7% IBS-D, IBS-M 33.7% and 0.5% IBS-U) with refractory IBS were included. Compared to those seen in the 12-months before the pandemic (n=107), the cohort seen during the Covid-19 pandemic (n=83) had a significantly higher median IBS-SSS (318 vs. 352, p=0.03), and more extra-intestinal symptoms (non-colonic score: 225 vs. 269, p=0.03). During the pandemic, median abdominal pain (50 vs. 63, p=0.05) and abdominal distension scores (60 vs. 75, p=0.008) were significantly higher, and patients that were unmarried had a higher median IBS symptom severity (IBS-SSS: 320 vs. 359, p=0.03). Interestingly, those seen during the pandemic had more difficulty with sleep (53 vs. 68, p=0.03), and more feelings of helplessness and loss of control (50 vs. 70, p=0.02), compared to those seen before the pandemic. There was no difference in the levels of anxiety and depression between the pre and post lockdown groups (HAD-Anxiety: 11 vs. 11.5, p=0.96;HAD-Depression: 8 vs. 8, p=0.84).ConclusionsThis study has shown for the first time that patients seen in tertiary care with refractory IBS during the covid-19 pandemic had a significantly higher symptom burden emphasising the importance of gut-brain axis in IBS. Furthermore, lack of support and perceived loss of control appear to be contributory factors.