key: cord-1008811-k63ujgt1
authors: Oliviero, Giovanni; Ruggiero, Luigi; D’Antonio, Elvira; Gagliardi, Mario; Nunziata, Rubino; Di Sarno, Alessandro; Abbatiello, Carmelina; Di Feo, Elvira; De Vivo, Simona; Santonicola, Antonella; Iovino, Paola
title: Replay to Response to Oliviero et al.’s Publication: “Impact of COVID‐19 lockdown on symptoms in patients with functional gastrointestinal disorders: Relationship with anxiety and perceived stress”
date: 2021-09-09
journal: Neurogastroenterol Motil
DOI: 10.1111/nmo.14263
sha: 937ef80881de0d91cfa4ecedfb6fe34c65fe12ba
doc_id: 1008811
cord_uid: k63ujgt1

nan

Previous studies underlined how stress conditions and mood disorders such as anxiety and depression could influence pain levels in IBS patients, and gastric discomfort in FD patients, due to the alteration of visceral pain stimuli brain processing and of colonic and gastric motility patterns. [1] [2] [3] [4] [5] Furthermore, it has been deeply reported in literature that depression and anxiety occur in most of FGID patients and that are able to condition GI symptoms onset and maintenance, interfering with gastrointestinal motor function and sensitivity, specifically activating autonomic or brain response to stress situations. 1, [6] [7] [8] [9] In this context, Dr. Wang's and our data are perfectly in line with the previous literature demonstrating and confirming how psychological stress and anxiety could modulate FGID symptoms onset, maintenance, and severity, often in a negative way.

However, we must clarify that these findings represent only a partial slice of our study results. Indeed, we found that despite COVID-19 lockdown having forced an adaptation to home restrictions, the intensity-frequency scores of several upper GI symptoms improved. These results appeared quite surprising but in apparent contrast with previous studies, so becoming possible matter of debate.

Nevertheless, we tried to give some explications to this finding: 1-focusing attention on an organic disease such as COVID-19 might have lightened functional symptoms 10 ; 2-the level of fear of getting COVID-19 was lower in the studied population since it was from Campania, an Italian region that was affected by the first pandemic wave much less than other northern regions; 3-the patients' resilience as a psychological aspect able to influence symptoms improvement 11 ; and 4-eating at home a Mediterranean diet or, at least, having a more regular meals despite having quick and qualitatively unhealthy meals could improve GI symptoms.

In our study, we have not considered, among possible causes of anxiety, the COVID-19-related financial concerns that, as Dr. Wang and colleagues correctly showed, were linked to higher anxiety levels and consequently to higher pain levels, dissatisfaction, and interference to life. The analysis they reported fit perfectly with the concept of national health system adopted in the United States, which differs profoundly from the Italian one, completely open to all patients' health needs, so without financial burden.

Finally, COVID-19 outbreak has severely tested our health system, making us neglect various categories of patients such as those suffering functional GI symptoms. This concept must lead us to reflect deeply on our current FGID patients' management, and we deeply agree with the need to improve and develop new modalities of healthcare assistance such as telehealth or telemedicine.

Luigi Ruggiero

Is there a causal link between psychological disorders and functional gastrointestinal disorders?

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The role of psychosocial factors and psychiatric disorders in functional dyspepsia

Chronic pain in irritable bowel syndrome and other comorbid pain conditions

The sympathetic nervous system modulates perception and reflex responses to gut distention in humans

Stress and the gut: pathophysiology, clinical consequences, diagnostic approach and treatment options

Anxiety and depression as markers of multiplicity of sites of functional gastrointestinal disorders: a gender issue?

State and trait anxiety and depression in patients affected by gastrointestinal diseases: psychometric evaluation of 1641 patients referred to an internal medicine outpatient setting

Irritable bowel syndrome in childhood: visceral hypersensitivity and psychosocial aspects

Attention and distraction: effects on gut perception

Resilience is decreased in irritable bowel syndrome and associated with symptoms and cortisol response

Replay to Response to Oliviero et al.'s Publication: "Impact of COVID-19 lockdown on symptoms in patients with functional gastrointestinal disorders: Relationship with anxiety and perceived stress