From irritable bowel syndrome comorbid with post-COVID- 19 syndrome to syndemia

Abstract

Irritable bowel syndrome (IBS) is a common functional disorder, and in the context of the post-COVID-19 syndrome, a comorbidity between the two is increasingly observed. This association involves immunological, infectious and psychoemotional factors, outlining a complex clinical picture. Beyond simple coexistence, the interaction of these conditions reflects a syndemic-type dynamic, in which the biological component is intertwined with the social and psychological context. The article analyzes this evolution from comorbidity to syndemic, with important implications for clinical practice. The current study included 39 patients with IBS + post-COVID syndrome (NICE) + obesity (BMI = 30-34.9 kg/[(m)2]). The mean age was 42 ± 2.8 years; the female/male ratio was 3:2. Patients underwent fibrocolonoscopy (FCS) with biopsy, Stool Ag-test Hp, CDI (Cl. difficile infection, toxins A, B, AB), calprotectin assessment (quantitative/qualitative), onco-markers (CEA, CA-19.9, CA-153, CA-125), lipidogram, blood glucose control, Glomerular Filtration Rate assessment (eGFR, CKD-EPI). The division according to ROMA IV revealed predominantly IBS with diarrhea (15 patients - 38.5%) and mixed IBS (11 patients - 28.2%), of which 19 patients (73%) also demonstrated the presence of MASLD (metabolic dysfunction-associated steatotic liver disease). According to the criteria of cardiometabolic syndrome (CM), the eGFR examination also reflected CKD st. G3a-b, that is Cardio-Reno-Metabolic syndrome (CaReMe) – which is syndemia, and is explained by the disruption of mucosal integrity, low-intensity inflammation. Comorbidity of IBS with post-COVID-19 syndrome (presence of MASLD→CaReMe) is an overlap syndrome. Management of these patients requires a comprehensive, multidisciplinary approach by the family doctor, but treatment also involves the inclusion of synbiotics, metabiotics, Rifaximin, Rebamipide, GLP-1 RA and i-SGLT-2.