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Post COVID-19 irritable bowel syndrome
  1. Giovanni Marasco1,2,
  2. Cesare Cremon1,2,
  3. Maria Raffaella Barbaro1,
  4. Giulia Cacciari1,2,
  5. Francesca Falangone3,
  6. Anna Kagramanova4,
  7. Dmitry Bordin4,5,6,
  8. Vasile Drug7,
  9. Egidia Miftode8,
  10. Pietro Fusaroli9,
  11. Salem Youssef Mohamed10,
  12. Chiara Ricci11,
  13. Massimo Bellini12,
  14. Mohammed Masudur Rahman13,
  15. Luigi Melcarne14,
  16. Javier Santos15,
  17. Beatriz Lobo15,
  18. Serhat Bor16,
  19. Suna Yapali17,
  20. Deniz Akyol18,
  21. Ferdane Pirincci Sapmaz19,
  22. Yonca Yilmaz Urun20,
  23. Tugce Eskazan21,
  24. Altay Celebi22,
  25. Huseyin Kacmaz23,
  26. Berat Ebik24,
  27. Hatice Cilem Binicier25,
  28. Mehmet Sait Bugdayci26,
  29. Munkhtsetseg Banzragch Yağcı27,
  30. Husnu Pullukcu18,
  31. Berrin Yalınbas Kaya20,
  32. Ali Tureyen20,
  33. İbrahim Hatemi21,
  34. Elif Sitre Koc17,
  35. Goktug Sirin22,
  36. Ali Riza Calıskan23,
  37. Goksel Bengi25,
  38. Esra Ergun Alıs28,
  39. Snezana Lukic29,
  40. Meri Trajkovska30,
  41. Keren Hod31,
  42. Dan Dumitrascu32,
  43. Antonello Pietrangelo33,
  44. Elena Corradini33,
  45. Magnus Simren34,
  46. Jessica Sjölund34,
  47. Navkiran Tornkvist34,
  48. Uday C Ghoshal35,
  49. Olga Kolokolnikova36,
  50. Antonio Colecchia37,
  51. Jordi Serra38,
  52. Giovanni Maconi39,
  53. Roberto De Giorgio40,
  54. Silvio Danese41,
  55. Piero Portincasa42,
  56. Antonio Di Sabatino43,
  57. Marcello Maggio44,
  58. Elena Philippou45,
  59. Yeong Yeh Lee46,
  60. Daniele Salvi2,
  61. Alessandro Venturi1,
  62. Claudio Borghi1,2,
  63. Marco Zoli2,
  64. Paolo Gionchetti1,2,
  65. Pierluigi Viale1,2,
  66. Vincenzo Stanghellini1,2,
  67. Giovanni Barbara1,2
  68. the GI-COVID19 study group
    1. 1 Azienda Ospedaliero-Universitaria di Bologna IRCCS, Bologna, Emilia-Romagna, Italy
    2. 2 Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
    3. 3 Medical-Surgical Department of Clinical Sciences and Translational Medicine, University Sapienza Rome, Rome, Italy
    4. 4 Loginov Moscow Clinical Scientific Center, Moscow, Russian Federation
    5. 5 Tver State Medical University, Tver, Russian Federation
    6. 6 Medicine and Dentistry, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
    7. 7 Gastroenterology, Grigore T Popa University of Medicine and Pharmacy Faculty of Medicine, Iasi, Romania
    8. 8 Department of Infectious Diseases, 'Grigore T Popa' University of Medicine and Pharmacy, Iasi, Romania
    9. 9 Gastroenterology Unit, University of Bologna, Imola, Italy
    10. 10 Internal Medicine Department, Zagazig University, Zagazig, Egypt
    11. 11 Gastroenterology Unit, University of Brescia, Brescia, Italy
    12. 12 Department of New Technologies and Translational Research in Medicine and Surgery, University of Pisa, Pisa, Italy
    13. 13 Department of Gastroenterology, Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh
    14. 14 Gastroenterology Department, Hospital Universitario Parc Tauli, Sabadell, Cataluña, Spain
    15. 15 Digestive System Research Unit, Hospital General Vall D'Hebron, Barcelona, Spain
    16. 16 Ege University School of Medicine, Izmir, Turkey
    17. 17 Division of Gastroenterology, Acibadem University, Altunizade Acibadem Hospital, Istanbul, Turkey
    18. 18 Department of Infectious Diseases, Ege University, Izmir, Turkey
    19. 19 Division of Gastroenterology, University of Health Sciences, Keciören Education and Research Hospital, Keciören, Turkey
    20. 20 Division of Gastroenterology, Eskisehir City Hospital, Eskisehir, Turkey
    21. 21 Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Division of Gastroenterology, Turkey
    22. 22 Division of Gastroenterology, Kocaeli University, Kocaeli, Turkey
    23. 23 Division of Gastroenterology, Adiyaman Education and Research Hospital, Adiyaman, Turkey
    24. 24 Division of Gastroenterology, University of Health Sciences, Diyabakır Gazi Yasargil Education and Research Hospital, Diyarbakır, Turkey
    25. 25 Division of Gastroenterology, Dokuz Eylül University, Izmir, Turkey
    26. 26 Division of Gastroenterology, İstanbul Aydın University Florya Liv Hospital, Istanbul, Turkey
    27. 27 Division of Gastroenterology, Darıca Farabi Education and Research Hospital, Kocaeli, Turkey
    28. 28 Department of Infectious Diseases, İstanbul Aydın University Florya Liv Hospital, Istanbul, Turkey
    29. 29 Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, Beograd, Beograd, Serbia
    30. 30 Clinic of Gastroenterohepatology, Skopje, Macedonia (the former Yugoslav Republic of)
    31. 31 Research Division, Assuta Medical Center, Tel Aviv, Tel Aviv, Israel
    32. 32 2nd Medical Department of Internal Medicine, University of Medicine and Pharmacy, Cluj-Napoca, Romania
    33. 33 Division of Internal Medicine, University of Modena and Reggio Emilia, Modena, Italy
    34. 34 Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
    35. 35 Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
    36. 36 Medsi Clinical Hospital, Moscow, Russian Federation
    37. 37 Division of Gastroenterology, University of Modena and Reggio Emilia, Modena, Italy
    38. 38 CIBERehd, University Hospital Germans Trias i Pujol, Barcelona, Spain
    39. 39 Gastroenterology, L.Sacco University Hospital, Milan, Italy
    40. 40 Department of Translational Medicine, University of Ferrara, Ferrara, Italy
    41. 41 Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milano, Italy
    42. 42 Division of Internal Medicine “A. Murri”, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, Bari, Italy
    43. 43 First Department of Internal Medicine, Università degli Studi di Pavia Facoltà di Medicina e Chirurgia, PV, Lombardia, Italy
    44. 44 Geriatric Clinic Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
    45. 45 Department of Life and Health Sciences, Cyprus University of Nicosia, Nicosia, Cyprus
    46. 46 School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
    1. Correspondence to Dr Giovanni Barbara, Azienda Ospedaliero-Universitaria di Bologna IRCCS, Bologna, Emilia-Romagna, Italy; giovanni.barbara{at}


    Objectives The long-term consequences of COVID-19 infection on the gastrointestinal tract remain unclear. Here, we aimed to evaluate the prevalence of gastrointestinal symptoms and post-COVID-19 disorders of gut–brain interaction after hospitalisation for SARS-CoV-2 infection.

    Design GI-COVID-19 is a prospective, multicentre, controlled study. Patients with and without COVID-19 diagnosis were evaluated on hospital admission and after 1, 6 and 12 months post hospitalisation. Gastrointestinal symptoms, anxiety and depression were assessed using validated questionnaires.

    Results The study included 2183 hospitalised patients. The primary analysis included a total of 883 patients (614 patients with COVID-19 and 269 controls) due to the exclusion of patients with pre-existing gastrointestinal symptoms and/or surgery. At enrolment, gastrointestinal symptoms were more frequent among patients with COVID-19 than in the control group (59.3% vs 39.7%, p<0.001). At the 12-month follow-up, constipation and hard stools were significantly more prevalent in controls than in patients with COVID-19 (16% vs 9.6%, p=0.019 and 17.7% vs 10.9%, p=0.011, respectively). Compared with controls, patients with COVID-19 reported higher rates of irritable bowel syndrome (IBS) according to Rome IV criteria: 0.5% versus 3.2%, p=0.045. Factors significantly associated with IBS diagnosis included history of allergies, chronic intake of proton pump inhibitors and presence of dyspnoea. At the 6-month follow-up, the rate of patients with COVID-19 fulfilling the criteria for depression was higher than among controls.

    Conclusion Compared with controls, hospitalised patients with COVID-19 had fewer problems of constipation and hard stools at 12 months after acute infection. Patients with COVID-19 had significantly higher rates of IBS than controls.

    Trial registration number NCT04691895.

    • COVID-19
    • irritable bowel syndrome

    Data availability statement

    Data are available upon reasonable request. Data are available on reasonable request. All figures have associated raw data. The additional data that support the findings of this study are available from the corresponding author by request.

    This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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    Data availability statement

    Data are available upon reasonable request. Data are available on reasonable request. All figures have associated raw data. The additional data that support the findings of this study are available from the corresponding author by request.

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    • Collaborators Alessio Piacentini, Mariam Shengelia, Valeriy Vechorko, Carla Cardamone, Claudia Agabiti Rosei, Andrea Pancetti, Francesco Rettura, Marc Pedrosa, Adoración Nieto, Claudia Barber, Alejandro Henao, Caterina Campoli, Dragana Mijac, Milos Korac, Uros Karic, Aleksandar Markovic, Ana Najdeski, Dafina Nikolova, Marija Dimzova, Orly Lior, Nadav Shinhar, Ori Perelmutter, Yehuda Ringel, Cristina Marica Sabo, Ana Chis, Gregorio Bonucchi, Giacomo Pietro Ismaele Caio, Caterina Ghirardi, Beatrice Marziani, Barbara Rizzello, Ariadna Aguilar, Domenica Maria Di Paolo, Leonilde Bonfrate, Giovanni Marconi, Michele Di Stefano, Sara Tagliaferri, Juan Enrique Naves, Andrea Galli, Gabriele Dragoni, Laurentiu Nedelcu, Milena Stevanovic, Ance Volkanovska Nikolovska, Antonio Capogreco, Alessio Aghemo, Paula Antonia Mauloni, Sara Del Vecchio, Luca Rotondo, Federica Capuani, Davide Montanari, Francesco Palombo, Clara Paone, Giada Mastel, Claudia Fontana, Lara Bellacosa, Rosanna F. Cogliandro.

    • Contributors GB, GMarasco, CC, and VS designed the study; all authors collected data for the study; GMarasco carried out statistical analysis; GMarasco, GB, and CC validated and interpretated data; GB, GMarasco, CC, and VS drafted the manuscript; and all authors critically revised, approved, and agree on all aspects of the final version of the manuscript. GB is the guarantor of the article.

    • Funding GB’s contribution to this research was partly supported by funding from Fondazione Cassa di Risparmio in Bologna, the Italian Ministry of Education, University and Research; and Fondazione del Monte di Bologna e Ravenna and European Grant H2020, DISCOvERIE, SC1-BHC-01-2019

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.