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Infectious Gastroenteritis Linked to Irritable Bowel Syndrome

Laurie Barclay, MD

Sept. 25, 2003 — Infectious gastroenteritis is associated with the development of irritable bowel syndrome (IBS), according to the results of a prospective, community-based study published in the September issue of the American Journal of Gastroenterology.

"IBS might develop after gastroenteritis," write Sally D. Parry, from the University of Newcastle in the U.K., and colleagues. "Most previous studies of this relationship have been uncontrolled, and little is known regarding other functional gastrointestinal disorders (FGIDs) after gastroenteritis."

In this case-control study, cases had proven bacterial gastroenteritis, and control patients were community-based. Self-administered Rome II modular questionnaires diagnosed FGIDs at baseline, three, and six months. Subjects with prior FGIDs were excluded from the study. Of 500 identified cases, 265 patients (53%) consented to take part in the study, as did 705 control patients, of whom 219 were eligible. Six-month questionnaire data were available for 108 cases and 206 controls.

The primary end point, defined as the presence of one of the three specific FGIDs at six months, occurred in significantly more cases than in controls (27 [25%] vs. 6 [2.9%]; OR = 11.11; 95% confidence interval [CI], 4.42 - 27.92). At three months, 29% of cases and 2.9% of controls had an FGID.

Although functional dyspepsia was uncommon in both case and control patients, IBS was diagnosed in 18 cases (16.7%) and four controls (1.9%; OR = 10.1; 95% CI, 3.32 - 30.69), and functional diarrhea was diagnosed in six cases (5.6%) and in no control patients.

Study limitations include very low participation rate, exclusion of a significant proportion of potential subjects because of a pre-existing FGID, fairly high drop-out rate, and lack of endoscopic data.

"Symptoms consistent with IBS and functional diarrhea occur more frequently in people after bacterial gastroenteritis compared with controls, even after careful exclusion of people with pre-existing FGIDs," the authors write. "The proportion of patients with an FGID was maintained between 3 and 6 months, which suggests that the symptoms are likely to be long-lasting. Clearly, more needs to be known about the natural history of FGIDs after bacterial gastroenteritis, and the field of postinfectious IBS is rich in possibilities for discovering more about the pathoetiology of these common gut disorders."

Northumbria NHS Healthcare Trust funded this study.

Am J Gastroenterol. 2003;98 (9):1970-1975

Reviewed by Gary D. Vogin, MD

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