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Post-infectious

By on June 29, 2016

Post-infectious Irritable Bowel Syndrome: How Acute

Irritable bowel syndrome (IBS) is a common chronic GI disorder classified as a group of symptoms. These symptoms include pain in the abdominal region and changes in the pattern of bowel movements without any evidence of underlying damage. (1)

Data from the NHS shows that Irritable bowel syndrome (IBS) accounts for around 2% of all GP visits and it is estimated that 30–40% of gastroenterological outpatient visits are attributed to IBS. (2, 3)`

Symptoms can last days, weeks, months or even years affecting both the physical and the mental wellbeing of those involved. Disorders such as depression, anxiety, panic attacks, fibromyalgia and chronic fatigue syndrome are associated with it. (4)

In a study from Professor R. Spiller from the division of Gastroenterology at Nottingham University looked at both the physical and mental health of 436 individuals. 25 of these had Post Infection IBS (PI-IBS) and 32 had previous IBS symptoms.  His team collated data and compared it to a control study of non-affected individuals. (7)

Capture9

Figure 1 shows the average number of outpatient visits per year for IBS. In the study Spiller found that individuals who experienced IBS symptoms were twice as likely to visit outpatients, 33 times more likely to have to visit a hospital for GI-associated symptoms, nearly twice as likely for non-GI symptoms and more than twice as likely to see mental health clinical staff when compared to the control group. (7)

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This study shows that the gastrointestinal symptoms associated with IBS are very high. It is also assumed that rather being as a result of pathophysiological mechanisms it is more psychological as psychiatric disorders, especially major depression, anxiety, and somatoform disorders (mental health problems that cause physical disorders) can occurs in up to 94%. In PI-IBS cases, the study showed that six years post-initial infection many were still symptomatic.

However, in more recent studies by Spiller and data from the CDC, Public Health England and clinical trials it is believed that around 6-17% of patients with IBS symptoms believe their symptoms first originated post-infection (Gastroenteritis). This is an acute illness which is demonstrated by two or more of the following: fever, vomiting, diarrhea and a positive stool culture. During the later study a survey of 840 people who were infected with C. jejuni enteritis 103 of these individuals developed PI-IBS. This would suggest it was less a psychiatric disorder. It has many risk factors but is predominantly genetic showing familial tendencies. However studies have also shown that bacterial toxins also play an important role. Other factors include changes to the gut flora and nerves of the lower digestive system. 8

It is however difficult to diagnose PI-IBS. The identification of the original gastroenteritis infection usually requires a positive stool culture. This isn’t always available especially those who have caught it overseas and wouldn’t always have access to a doctor.

You can therefore conclude that PI-IBS develops after bacterial, viral or protozoan infections. From the studies of Spiller et al risk factors such as the severity of the initial acute illness were paramount.

As we’ve seen from reports, travellers are of a particularly high risk of PI-IBS. This can be accounted for by lower standards of health and safety, food preparatory standards or if they do, are not followed up with vigour.

It is therefore very important, for any travellers to ensure if they do have any of the symptoms associated with acute gastroenteritis, they seek medical attention, and as soon as possible given clinical testing to properly diagnose and receive effective treatment. This then will help those affected with PI-IBS to ensure that the symptoms can be attributed to the correct cause.

Keywords

Post-infectious irritable bowel syndrome;

PI-IBS;

Infectious diarrhoea;

Professor R. Spiller;

Acute Gastroenteritis;

Gastroenteritis;

References

1. "Definition and Facts for Irritable Bowel Syndrome". NIDDKD. 23 February 2015. Retrieved 29 March 2016

2. Thompson WG, Heaton KW, Smyth GT, et al. Irritable bowel syndrome in general practice: prevalence, characteristics, and

referral. Gut2000;46:78–82.

3. Wells NE, Hahn BA, Whorwell PJ. Clinical economics review: irritable bowel syndrome. Aliment Pharmacol

Ther1997;11:1019–30

4. "Symptoms and Causes of Irritable Bowel Syndrome". NIDDK. 23 February 2015. Retrieved 29 March 2016.

5. Hulisz D (2004). "The burden of illness of irritable bowel syndrome: current challenges and hope for the future". J Manag Care

Pharm. 10 (4): 299–309. PMID 15298528

6. Whitehead WE, Palsson O, Jones KR; Palsson; Jones (2002). "Systematic review of the comorbidity of irritable bowel

syndrome with other disorders: what are the causes and implications?". Gastroenterology 122 (4): 1140–56

7. K R Neal, L Barker, R C Spiller Prognosis in post-infective irritable bowel syndrome: a six year follow up study. Gut

2002;51:410-413 doi:10.1136/gut.51.3.410

8. R Spiller and Ching Lam J Neurogastroenterol Motil, Vol. 18 No. 3 July, 2012 pISSN: 2093-0879 eISSN: 2093-0887

http://dx.doi.org/10.5056/jnm.2012.18.3.258

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