Long-term Clinical Course of Post-infectious Irritable Bowel Syndrome After Shigellosis: A 10-year Follow-up Study

Abstract

Background/AimsA limited number of studies are available regarding the long-term natural history of post-infectious irritable bowel syndrome (PI-IBS). We aimed to investigate the long-term clinical course of PI-IBS. MethodsA prospective cohort study was conducted from a 2001 shigellosis outbreak in a Korean hospital with about 2000 employees. A cohort of 124 hospital employees who were infected by Shigella sonnei due to contaminated food in the cafeteria, and 105 sex-and age-matched, non-infected, controls were serially followed for their bowel symptoms by questionnaire surveys for 10 years. ResultsThe Shigella-infected cohort showed significantly higher odds ratio for irritable bowel syndrome (IBS) at 1-year (11.90; 95% CI, 1.49-95.58) and 3-year (3.93; 95% CI, 1.20-12.86) follow-up, compared to their controls. However, corresponding odds ratio for PI-IBS was not significantly increased at 5-year (1.88; 95% CI, 0.64-5.54) and 8-year (1.87; 95% CI, 0.62-5.19) follow-up. At 10-year followup survey, the prevalence of IBS was similar for the Shigella-infected cohort and their controls (23.3% versus 19.7%, P = 0.703). Risk factors which were independently associated with PI-IBS among the Shigella-infected cohort included younger age, previous history of functional bowel disorder, and longer duration of diarrhea at baseline. ConclusionsPatients who were infected by Shigella sonnei experienced significantly increased risk of IBS until 3 years after shigellosis, and modestly increased risk until 8 years, but showed similar risk of IBS with uninfected controls at 10 years post-infection. PI-IBS is quite a chronic disorder, and follows a long-term natural course.

Prevalence, Risk Factors, and Outcomes of Irritable Bowel Syndrome After Infectious Enteritis: A Systematic Review and Meta-analysis

“…Overall, the rates of PI-IBS were highest after protozoal/parasitic IE, 11–13, 46 followed by bacterial IE, 4, 5, 17, 2015, 31, 34, 35, 38–44, 47, 50–55, 57, 58 and lowest rates were seen with viral IE 7–10 (Figure 2). Summary estimate shows significant heterogeneity (I 2 ≥95%) among studies.…”

Prevalence of Irritable Bowel Syndrome and Chronic Fatigue 10 Years After Giardia Infection

“…A recently published 10-year follow-up study found a significant association between exposure to shigellosis and PI-IBS 1 and 3 years after the infection, but no significant association 5, 8, or 10 years later. 7 The Walkerton outbreak had a follow-up time of 8 years, and found that exposure to a mixture of bacterial pathogens was associated with PI-IBS 8 years after exposure, with a prevalence of PI-IBS among exposed of 15.4%. 6 Previous research has suggested that bacterial pathogens cause longer lasting symptoms of PI-IBS than viral pathogens.…”

“…3,5 Postinfectious IBS (PI-IBS) has been described following outbreaks, among travelers returning from abroad, or as sporadic cases. [5][6][7][8][9][10] The rate of recovery from PI-IBS varies between studies, and bacterial infections seem to be associated with more prolonged symptoms than viral infections. 10 One study after an outbreak of bacterial dysentery reported that IBS was associated with exposure up to 8 years after the acute infection.…”

“…6 A more recent study found that IBS was associated with shigellosis after 1 and 3 years' postexposure follow-up, but not after 5, 8, or 10 years. 7 Postinfectious CF as part of CFS has been reported as a complication after various acute viral and bacterial infections. 3,[11][12][13][14] In the autumn of 2004, the parasite Giardia lamblia contaminated 1 of the municipal drinking-water reservoirs in Bergen, likely due to broken sewage pipes.…”

“…1072.e2 Litleskare et alClinicalGastroenterology and Hepatology Vol. 16,No. 7 SupplementaryTable 3 with Figure.…”