Effect of covid related restrictions on irritable bowel syndrome psychological well-being. a comparative study with ulcerative colitis

Introduction: Patients with Irritable bowel syndrome (IBS) have been reported to have higher anxiety and depression levels than general population, as well as dysfunctional coping skills. The total/ partial lockdown due to COVID19 pandemic has been related with an increased incidence of psychological disorders in general population;however, its effect on IBS patients and patients with other chronic GI-conditions like ulcerative colitis (UC) is not known. Aims & Methods: The main goal of this study was to compare the lockdown effect on mental health and digestive symptoms in patients with IBS, UC and healthy volunteers. During April 2020 (Spanish total lockdown), 30 IBS, 30 UC in remission and 30 healthy volunteers were invited to answer an online survey evaluating stress and anxiety levels by the STAI questionnaire and depression using the Beck questionnaire. IBS patients' symptoms were evaluated with IBS-SSS. After 6 months, in October 2020 (partial lockdown in Spain), the same subjects were contacted, and they were asked to answer again the same online questionnaires. Results: Responses were obtained from 24 IBS (67% women, aged 21-67 years), 23 UC (56% women, aged 35-55 years) and 18 healthy volunteers (68% women, aged 23-70 years). During total lockdown, IBS patients presented higher depression index (11.52±1.6) than UC patients (5.78±0.9 (p=0.008)) and healthy volunteers (4.78±4.3 (p=0.001)). IBS patients also had higher anxiety index (state 29.4±2.5 / trait 26.5±2.5) than healthy volunteers (state 15.6±2.3 (p=0.001) / trait 14.4±1.9 (p=0.002)). After 6 months (during partial lockdown) depression levels increased significatively in IBS patients (from 11.52±1.6 to 16.08±2.22 (p=0.012)), but remained unchanged in healthy subjects and UC patients (from 4.78±4.3 to 3.28±0.6 and from 5.78±0.9 to 5.91±1.17 respectively;p< 0.001 vs IBS). Anxiety scores (both state and trait) remained stable during the partial lockdown (6 months after the total lockdown) in the 3 study groups. The severity of digestive symptoms remained unchanged in IBS patients (scores 283±80 and 285±84, total and partial lockdown, respectively;p=0.837). Conclusion: During the lockdown due to COVID-19 pandemic, IBS patients presented higher depression and anxiety levels than healthy volunteers and patients with UC in remission. Additionally, the depression index worsened in IBS patients during the pandemic, while it remained stable in healthy volunteers and UC patients. During this first phase of the pandemic, the observed changes in psychological traits did not impact on abdominal symptoms, but carefully monitoring of IBS patients in the next months seems to be crucial to evaluate the potential repercussion of worsened mental health due to COVID-19 pandemic in IBS.