Table 1.

Management Considerations for Post-COVID-19 Irritable Bowel Syndrome

“Positive” diagnosis •Rome IV criteria •Limit diagnostic work-up unless “alarm symptoms” are present Reassurance and explanation that symptoms may improve or resolve over time Lifestyle modifications •Adequate sleep •Exercise Dietary modifications •High-fiber diet •Low FODMAP diet •Gluten-free diet •Low-carbohydrate diet •Selective elimination diets Symptom-based pharmacotherapy • Diarrhea-predominant • Loperamide • 5-HT3 antagonists: alosetron, ondansetron • Mixed opioid agonist and antagonist: eluxadoline • Antispasmodics • Antibiotic: rifaximin • Bile acid sequestrant • Constipation-predominant • Fiber supplement • Polyethylene glycol • Secretagogues: linaclotide, plecanatide, lubiprostone, tenapanor • 5-HT4 agonists: tegaserod, prucalopride • Mixed • Avoid treatment for bowel dysfunction if possible Neuromodulation •Tricyclic antidepressants •Tetracyclic antidepressants, selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, azapirones, delta ligands Psychological therapy •Cognitive behavioral therapy •Gut-directed hypnotherapy Microbiota modulation •Probiotic therapy Modulation of intestinal permeability •Glutamine

NOTE. In the absence of targeted clinical trials, these recommendations are based on expert opinion and on extrapolation of treatment for irritable bowel syndrome. Individual patient factors and side effect profiles should be considered.