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Is IBS caused by infectious diarrhea?

Nature Clinical Practice Gastroenterology & Hepatology volume 4, pages 642–643 (2007)Cite this article

After an initial report describing the onset of IBS in over a third of patients recovering from an outbreak of Salmonella enteritis, numerous reports have confirmed the existence of an entity known as post-infective IBS (PI-IBS). Symptoms of PI-IBS are largely a continuation of those of the original infection (albeit of lesser severity), namely abdominal cramps and loose stools. These symptoms fit the criteria for IBS with diarrhea or, in a small proportion of cases, IBS with mixed bowel habit.1 A meta analysis2 reported an odds ratio of 7.3 (95% CI 4.8–11.1) for the development of IBS after a gastrointestinal infection compared with uninfected individuals, indicating that infection is certainly one factor responsible for causing IBS with diarrhea. It is less certain, however, what proportion of all IBS cases are PI-IBS. One reason for this uncertainty is that although infectious gastroenteritis is very common in the community, affecting ∼20% of the UK population annually, only ∼1% of infections are reported on national registers. There were 81,000 cases of notifiable food poisoning in 2001 in England and Wales. Given that the population of these countries is 52 million, the annual incidence of gastroenteritis can be estimated as 1.2 cases per 1000 persons; however, the true incidence is likely to be at least an order of magnitude higher owing to underreporting. As ∼10% of gastroenteritis leads to the development of PI-IBS, the annual incidence of PI-IBS might, therefore, be 0.1–1.0 cases per 1,000 persons. By analysis of data from the UK General Practice Research Database, Rodriguez and Ruigomez3 recorded an annual incidence of 3.5 cases of IBS per 1,000 persons, indicating that 3–28% of new IBS cases could be PI-IBS; these figures are supported by the fact that 6–17% of patients with IBS report that their IBS began with an onset of infectious diarrhea.4 These observations suggest that PI-IBS accounts for an important minority of IBS cases.

The greatest significance of PI-IBS is perhaps that it has enabled the formulation of a detailed description of the risk factors for the development of IBS. These risk factors include genetic, environmental and psychosocial features as well as factors that are specific to the gut (such as infections in the case of PI-IBS) that interact to determine outcome (see supplementary figure online).

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References

  1. Dunlop SP et al. (2003) Relative importance of enterochromaffin cell hyperplasia, anxiety, and depression in postinfectious IBS. Gastroenterology 125: 1651–1659

    Article  Google Scholar 

  2. Halvorson HA et al. (2006) Postinfectious irritable bowel syndrome–a meta-analysis. Am J Gastroenterol 101: 1894–1899

    Article  Google Scholar 

  3. Rodriguez LA, Ruigomez A (1999) Increased risk of irritable bowel syndrome after bacterial gastroenteritis: cohort study. BMJ 318: 565–566.

    Article  CAS  Google Scholar 

  4. Longstreth GF et al. (2001) Characteristics of patients with irritable bowel syndrome recruited from three sources: implications for clinical trials. Aliment Pharmacol Ther 15: 959–964

    Article  CAS  Google Scholar 

  5. Barbara G et al. (2004) Activated mast cells in proximity to colonic nerves correlate with abdominal pain in irritable bowel syndrome. Gastroenterology 126: 693–702

    Article  Google Scholar 

  6. Dunlop SP et al. (2005) Abnormalities of 5-hydroxytryptamine metabolism in irritable bowel syndrome. Clin Gastroenterol Hepatol 3: 349–357

    Article  CAS  Google Scholar 

  7. Spiller RC (2007) Role of infection in irritable bowel syndrome. J Gastroenterol 42 (Suppl 17): 41–47

    Article  Google Scholar 

  8. Marshall JK et al. (2006) Incidence and epidemiology of irritable bowel syndrome after a large waterborne outbreak of bacterial dysentery. Gastroenterology 131: 445–450

    Article  Google Scholar 

  9. Marshall JK et al. (2007) Postinfectious irritable bowel syndrome after a food-borne outbreak of acute gastroenteritis attributed to a viral pathogen. Clin Gastroenterol Hepatol. 5 457–460

    Article  Google Scholar 

  10. Gwee KA et al. (1999) The role of psychological and biological factors in postinfective gut dysfunction. Gut 44: 400–406

    Article  CAS  Google Scholar 

  11. Okhuysen PC et al. (2004). Post-diarrhea chronic intestinal symptoms and irritable bowel syndrome in North American travelers to Mexico. Am J Gastroenterol 99: 1774–1778

    Article  Google Scholar 

  12. Neal KR et al. (2002) Prognosis in post-infective irritable bowel syndrome: a six year follow up study. Gut 51: 410–413

    Article  CAS  Google Scholar 

Download references

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  1. Wolfson Digestive Diseases Centre, C Floor South Block, University Hospital, Nottingham NG7 2UH, UK robin.spiller@nottingham.ac.uk

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  1. RC Spiller is Professor of Gastroenterology at the Wolfson Digestive Diseases Centre, University Hospital, Nottingham, UK.,

    Robin C Spiller

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The author has received research support from GlaxoSmithKline and Novartis.

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Spiller, R. Is IBS caused by infectious diarrhea?. Nat Rev Gastroenterol Hepatol 4, 642–643 (2007). https://doi.org/10.1038/ncpgasthep0983

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