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. 2025 May 15:e70079.
doi: 10.1111/nmo.70079. Online ahead of print.

Psychological and Clinical Factors Mediate Post-COVID-19 Irritable Bowel Syndrome

Keren Hod  1   2 , Giovanni Marasco #  3   4 , Luigi Colecchia #  3 , Cesare Cremon #  3   4 , Maria Raffaella Barbaro #  3 , Giulia Cacciari #  3   4 , Francesca Falangone  5 , Anna Kagramanova #  6   7 , Dmitry Bordin #  6   8   9 , Vasile Drug  10 , Egidia Miftode  11 , Pietro Fusaroli #  12 , Salem Youssef Mohamed  13 , Chiara Ricci #  14 , Massimo Bellini #  15 , M Masudur Rahman  16 , Luigi Melcarne #  17 , Javier Santos  18   19   20 , Beatriz Lobo  18 , Serhat Bor  21 , Suna Yapali  22 , Deniz Akyol  23 , Ferdane Pirincci Sapmaz  24 , Yonca Yilmaz Urun  25 , Tugce Eskazan  26 , Altay Celebi  27 , Huseyin Kacmaz  28 , Berat Ebik  29 , Hatice Cilem Binicier  30 , Mehmet Sait Bugdayci  31 , Munkhtsetseg Banzragch Yağcı  32 , Husnu Pullukcu  23 , Berrin Yalınbas Kaya  25 , Ali Tureyen  25 , İbrahim Hatemi  26 , Elif Sitre Koc  22 , Goktug Sirin  27 , Ali Riza Calıskan  28 , Goksel Bengi  30 , Esra Ergun Alıs  33 , Snezana Lukic #  34 , Meri Trajkovska #  35 , Dan Dumitrascu #  36 , Antonello Pietrangelo #  37 , Elena Corradini #  37 , Magnus Simren  38 , Jessica Sjolund  38 , Navkiran Tornkvist  38 , Uday C Ghoshal  39 , Olga Kolokolnikova  40 , Antonio Colecchia #  41 , Jordi Serra #  42 , Giovanni Maconi  43 , Roberto De Giorgio #  44 , Silvio Danese  45 , Piero Portincasa #  46 , Antonio Di Sabatino #  47 , Marcello Maggio #  48 , Elena Philippou  49 , Yeong Yeh Lee  50 , Daniele Salvi  4 , Alessandro Venturi  4 , Claudio Borghi #  3   4 , Marco Zoli #  3   4 , Paolo Gionchetti #  3   4 , Pierluigi Viale #  3   4 , Vincenzo Stanghellini #  3   4 , Giovanni Barbara #  3   4 ; GI‐COVID19 study group  51   52   53   54   55   56   57   58   59
Affiliations

Psychological and Clinical Factors Mediate Post-COVID-19 Irritable Bowel Syndrome

Keren Hod et al. Neurogastroenterol Motil. .

Abstract

Background: Exposure to COVID-19 has been shown previously to be associated with a higher risk for irritable bowel syndrome (IBS). This study aimed to better explain this relationship using mediation analysis.

Methods: This post hoc analysis of a multicenter cohort study includes 623 patients with and without COVID-19 infection. All participants completed the ROME IV criteria, gastrointestinal symptom rating scale (GSRS), and hospital anxiety and depression scale (HADS) over 1 year. Mediation analysis utilized the PROCESS macro and Baron and Kenny's method for parametric and nonparametric mediating variables, respectively.

Key results: The impact of COVID-19 on the development of post-COVID-19 IBS is completely mediated by dyspnea at baseline (adjusted OR = 3.561, p = 0.012), severity of acid regurgitation at 1 month [indirect effect, log-odds metric = 0.090, 95% CI (0.006-0.180)], hunger pains at 1 [indirect effect, log-odds metric = 0.094, 95% CI (0.024-0.178)], and 6 months [indirect effect, log-odds metric = 0.074, 95% CI (0.003-0.150)], depression at 6 [indirect effect, log-odds metric = 0.106, 95% CI (0.009-0.225)] and 12 months [indirect effect, log-odds metric = 0.146, 95% CI (0.016-0.311)] as well as borborygmus [indirect effect, log-odds metric = 0.095, 95% CI (0.009-0.203)], abdominal distention [indirect effect, log-odds metric = 0.162, 95% CI (0.047-0.303)], and increased flatus [indirect effect, log-odds metric = 0.110, 95% CI (0.005-0.234)] at 12 months.

Conclusions and inferences: Our findings provide evidence for psychological and clinical mediators between COVID-19 and post-COVID-19 IBS, which may be promising targets for interventions tailored for treating or preventing depression. The presence of specific GI symptoms at COVID-19 onset and their persistence should increase awareness of a potential new onset of IBS diagnosis.

Keywords: COVID‐19; depression; dyspnea; gastrointestinal symptoms; irritable bowel syndrome; mediation analysis.

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