Post‑infectious irritable bowel syndrome after a laboratory‑proven enteritis

Iacob,Teodora; Țățulescu,Doina   F.; Lupșe,Mihaela   S.; Dumitrașcu,Dan L.

doi:10.3892/etm.2020.9018

Post‑infectious irritable bowel syndrome after a laboratory‑proven enteritis

Authors:
- Teodora Iacob
- Doina F. Țățulescu
- Mihaela S. Lupșe
- Dan L. Dumitrașcu
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Affiliations: Department of Infectious Diseases, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 400348 Cluj‑Napoca, Romania, Second Medical Department, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
Published online on: July 16, 2020 https://doi.org/10.3892/etm.2020.9018
Pages: 3517-3522
Copyright: © Iacob et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

There are scarce data on risk factors for post‑infectious irritable bowel syndrome (PI‑IBS). The objective of this study was to determine the risk factors of developing PI‑IBS following an acute infectious gastroenteritis (AGE) episode in which, by laboratory tests, the etiological agent was isolated. The study was conducted on patients admitted to a tertiary center of infectious diseases during three consecutive years. The patients were divided into two groups: a group consisting of patients admitted with AGE (with an isolated etiological agent) and a control group consisting of patients admitted for an acute upper respiratory tract infection (URTI). The subjects were recalled in our center 6 months after the admission and were evaluated with Rome III IBS diagnostic questionnaire and Bristol Stool Form Scale. The questionnaires were paper printed and directly filled in by the subjects. The response rate in the case group was 5% and in the control group 100%. The prevalence of PI‑IBS was higher in patients with AGE, presenting a relative risk (RR) of 4.16 [95% confidence interval (CI), 1.89‑9.17], statistically significant (P<0.001) vs. URTI. From 28 female patients, 22 patients (79%) developed PI‑IBS and from 17 male patients, 3 patients (18%) had developed PI‑IBS with a risk of 4.4 (95% CI, 1.56‑12.65), P<0.001. Regarding the infectious etiology of the AGE, Campylobacter jejuni had the highest risk of developing PI‑IBS, RR=1.2 (95% CI, 0.13‑3.11), P=0.04 compared with the other agents with a lower risk. The risk to develop PI‑IBS after AGE infection is 4.16 higher than after URTI. Female sex is a risk factor for PI‑IBS, 79% of the female patients developed PI‑IBS after AGE. The incidence of PI‑IBS is highest in patients with Campylobacter jejuni AGE compared with the other agents.

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1	Drossman DA and Hasler WL: Rome IV-Functional GI Disorders: Disorders of gut-brain interaction. Gastroenterology. 150:1257–1261. 2016.PubMed/NCBI View Article : Google Scholar
2	Ericsson CD, Hatz C and DuPont AW: Postinfectious irritable bowel syndrome. Clin Infect Dis. 46:594–599. 2008.PubMed/NCBI View Article : Google Scholar
3	Thabane M, Kottachchi DT and Marshall JK: Systematic review and meta-analysis: The incidence and prognosis of post-infectious irritable bowel syndrome. Aliment Pharmacol Ther. 26:535–544. 2007.PubMed/NCBI View Article : Google Scholar
4	Thabane M and Marshall JK: Post-infectious irritable bowel syndrome. World J Gastroenterol. 15:3591–3596. 2009.PubMed/NCBI View Article : Google Scholar
5	Sethi S, Garey KW, Arora V, Ghantoji S, Rowan P, Smolensky M and DuPont HL: Increased rate of irritable bowel syndrome and functional gastrointestinal disorders after Clostridium difficile infection. J Hosp Infect. 77:172–173. 2011.PubMed/NCBI View Article : Google Scholar
6	Stewart GT: Post-dysenteric colitis. BMJ. 1:405–409. 1950.PubMed/NCBI View Article : Google Scholar
7	Kim HS, Kim MS, Ji SW and Park H: The development of irritable bowel syndrome after Shigella infection: 3 year follow-up study. Korean J Gastroenterol. 47:300–305. 2006.PubMed/NCBI(In Korean).
8	Ilnyckyj A, Balachandra B, Elliott L, Choudhri S and Duerksen DR: Post-traveler's diarrhea irritable bowel syndrome: A prospective study. Am J Gastroenterol. 98:596–599. 2003.PubMed/NCBI View Article : Google Scholar
9	Rodríguez LA and Ruigómez A: Increased risk of irritable bowel syndrome after bacterial gastroenteritis: Cohort study. BMJ. 318:565–566. 1999.PubMed/NCBI View Article : Google Scholar
10	Ruigómez A, García Rodríguez LA and Panés J: Risk of irritable bowel syndrome after an episode of bacterial gastroenteritis in general practice: Influence of comorbidities. Clin Gastroenterol Hepatol. 5:465–469. 2007.PubMed/NCBI View Article : Google Scholar
11	Soyturk M, Akpinar H, Gurler O, Pozio E, Sari I, Akar S, Akarsu M, Birlik M, Onen F and Akkoc N: Irritable bowel syndrome in persons who acquired trichinellosis. Am J Gastroenterol. 102:1064–1069. 2007.PubMed/NCBI View Article : Google Scholar
12	Piche T, Vanbiervliet G, Pipau FG, Dainese R, Hébuterne X, Rampal P and Collins SM: Low risk of irritable bowel syndrome after Clostridium difficile infection. Can J Gastroenterol. 21:727–731. 2007.PubMed/NCBI View Article : Google Scholar
13	Marshall JK, Thabane M, Borgaonkar MR and James C: Postinfectious irritable bowel syndrome after a food-borne outbreak of acute gastroenteritis attributed to a viral pathogen. Clin Gastroenterol Hepatol. 5:457–460. 2007.PubMed/NCBI View Article : Google Scholar
14	Marshall JK, Thabane M, Garg AX, Clark WF, Salvadori M and Collins SM: Walkerton Health Study Investigators. Incidence and epidemiology of irritable bowel syndrome after a large waterborne outbreak of bacterial dysentery. Gastroenterology. 131:445–450; quiz 660. 2006.PubMed/NCBI View Article : Google Scholar
15	Wang LH, Fang XC and Pan GZ: Bacillary dysentery as a causative factor of irritable bowel syndrome and its pathogenesis. Gut. 53:1096–1101. 2004.PubMed/NCBI View Article : Google Scholar
16	Neal KR, Hebden J and Spiller R: Prevalence of gastrointestinal symptoms six months after bacterial gastroenteritis and risk factors for development of the irritable bowel syndrome: Postal survey of patients. BMJ. 314:779–782. 1997.PubMed/NCBI View Article : Google Scholar
17	Borgaonkar MR, Ford DC, Marshall JK, Churchill E and Collins SM: The incidence of irritable bowel syndrome among community subjects with previous acute enteric infection. Dig Dis Sci. 51:1026–1032. 2006.PubMed/NCBI View Article : Google Scholar
18	Gwee KA, Leong YL, Graham C, McKendrick MW, Collins SM, Walters SJ, Underwood JE and Read NW: The role of psychological and biological factors in postinfective gut dysfunction. Gut. 44:400–406. 1999.PubMed/NCBI View Article : Google Scholar
19	Ji S, Park H, Lee D, Song YK, Choi JP and Lee SI: Post-infectious irritable bowel syndrome in patients with Shigella infection. J Gastroenterol Hepatol. 20:381–386. 2005.PubMed/NCBI View Article : Google Scholar
20	McKendrick MW and Read NW: Irritable bowel syndrome - post Salmonella infection. J Infect. 29:1–3. 1994.PubMed/NCBI View Article : Google Scholar
21	Mearin F, Badía X, Balboa A, Baró E, Caldwell E, Cucala M, Díaz-Rubio M, Fueyo A, Ponce J, Roset M, et al: Irritable bowel syndrome prevalence varies enormously depending on the employed diagnostic criteria: Comparison of Rome II versus previous criteria in a general population. Scand J Gastroenterol. 36:1155–1161. 2001.PubMed/NCBI View Article : Google Scholar
22	Gwee KA, Graham JC, McKendrick MW, Collins SM, Marshall JS, Walters SJ and Read NW: Psychometric scores and persistence of irritable bowel after infectious diarrhoea. Lancet. 347:150–153. 1996.PubMed/NCBI View Article : Google Scholar
23	Tuteja AK, Talley NJ, Gelman SS, Alder SC, Thompson C, Tolman K and Hale DC: Development of functional diarrhea, constipation, irritable bowel syndrome, and dyspepsia during and after traveling outside the USA. Dig Dis Sci. 53:271–276. 2008.PubMed/NCBI View Article : Google Scholar
24	Spence MJ and Moss-Morris R: The cognitive behavioural model of irritable bowel syndrome: A prospective investigation of patients with gastroenteritis. Gut. 56:1066–1071. 2007.PubMed/NCBI View Article : Google Scholar
25	Wei X, Chen M and Wang J: The epidemiology of irritable bowel syndrome and functional constipation of Guangzhou residents. Zhonghua Nei Ke Za Zhi. 40:517–520. 2001.PubMed/NCBI(In Chinese).
26	Spiller RC: Postinfectious irritable bowel syndrome. Gastroenterology. 124:1662–1671. 2003.PubMed/NCBI View Article : Google Scholar
27	Moss-Morris R and Spence M: To ‘lump’ or to ‘split’ the functional somatic syndromes: Can infectious and emotional risk factors differentiate between the onset of chronic fatigue syndrome and irritable bowel syndrome? Psychosom Med. 68:463–469. 2006.PubMed/NCBI View Article : Google Scholar
28	Parry SD, Stansfield R, Jelley D, Gregory W, Phillips E, Barton JR and Welfare MR: Does bacterial gastroenteritis predispose people to functional gastrointestinal disorders? A prospective, community-based, case-control study. Am J Gastroenterol. 98:1970–1975. 2003.PubMed/NCBI View Article : Google Scholar
29	Gupta A and Khanna S: Community-acquired Clostridium difficile infection: An increasing public health threat. Infect Drug Resist. 7:63–72. 2014.PubMed/NCBI View Article : Google Scholar
30	Gutiérrez RL, Riddle MS and Porter CK: Increased risk of functional gastrointestinal sequelae after Clostridium difficile infection among active duty United States military personnel (1998-2010). Gastroenterology. 149:1408–1414. 2015.PubMed/NCBI View Article : Google Scholar
31	Walker ARP and Segal I: Epidemiology of noninfective intestinal diseases in various ethnic groups in South Africa. Isr J Med Sci. 15:309–313. 1979.PubMed/NCBI
32	Buéno L, Fioramonti J and Garcia-Villar R: Pathobiology of visceral pain: molecular mechanisms and therapeutic implications. III. Visceral afferent pathways: a source of new therapeutic targets for abdominal pain. Am J Physiol Gastrointest Liver Physiol. 278:G670–G676. 2000.PubMed/NCBI View Article : Google Scholar
33	Neal KR, Barker L and Spiller RC: Prognosis in post-infective irritable bowel syndrome: A six year follow up study. Gut. 51:410–413. 2002.PubMed/NCBI View Article : Google Scholar
34	Rohde CL, Bartolini V and Jones N: The use of probiotics in the prevention and treatment of antibiotic-associated diarrhea with special interest in Clostridium difficile-associated diarrhea. Nutr Clin Pract. 24:33–40. 2009.PubMed/NCBI View Article : Google Scholar
35	Shukla G, Devi P and Sehgal R: Effect of Lactobacillus casei as a probiotic on modulation of giardiasis. Dig Dis Sci. 53:2671–2679. 2008.PubMed/NCBI View Article : Google Scholar
36	Resta-Lenert S and Barrett KE: Live probiotics protect intestinal epithelial cells from the effects of infection with enteroinvasive Escherichia coli (EIEC). Gut. 52:988–997. 2003.PubMed/NCBI View Article : Google Scholar
37	Drossman DA and Dumitrascu DL: Rome III: New standard for functional gastrointestinal disorders. J Gastrointestin Liver Dis. 15:237–241. 2006.PubMed/NCBI
38	Lewis SJ and Heaton KW: Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol. 32:920–924. 1997.PubMed/NCBI View Article : Google Scholar
39	Klem F, Wadhwa A, Prokop LJ, Sundt WJ, Farrugia G, Camilleri M, Singh S and Grover M: Prevalence, risk factors, and outcomes of irritable bowel syndrome after infectious enteritis: A systematic review and meta-analysis. Gastroenterology. 152:1042–1054.e1. 2017.PubMed/NCBI View Article : Google Scholar
40	Litleskare S, Rortveit G, Eide GE, Hanevik K, Langeland N and Wensaas KA: Prevalence of irritable bowel syndrome and chronic fatigue 10 years after Giardia infection. Clin Gastroenterol Hepatol. 16:1064–1072.e4. 2018.PubMed/NCBI View Article : Google Scholar
41	Mearin F, Pérez-Oliveras M, Perelló A, Vinyet J, Ibañez A, Coderch J and Perona M: Dyspepsia and irritable bowel syndrome after a Salmonella gastroenteritis outbreak: One-year follow-up cohort study. Gastroenterology. 129:98–104. 2005.PubMed/NCBI View Article : Google Scholar
42	Wadhwa A, Al Nahhas MF, Dierkhising RA, Patel R, Kashyap P, Pardi DS, Khanna S and Grover M: High risk of post-infectious irritable bowel syndrome in patients with Clostridium difficile infection. Aliment Pharmacol Ther. 44:576–582. 2016.PubMed/NCBI View Article : Google Scholar
43	Peterson LR, O'Grady S, Keegan M, Fisher A, Zelencik S, Kufner B, Shah M, Lim R, Schora D, Das S, et al: Reduced Clostridioides difficile infection in a pragmatic stepped-wedge initiative using admission surveillance to detect colonization. PLoS One. 15(e0230475)2020.PubMed/NCBI View Article : Google Scholar