Prognosis in post-infective irritable bowel syndrome: a six year follow up study

Abstract

Background: Irritable bowel syndrome developing following infective gastroenteritis accounts for approximately 1 in 10 of unselected IBS patients. Aims: To define the long term natural history of post-infective IBS (PI-IBS). Methods: A total of 436 individuals, who had previously responded to a questionnaire on their bowel habits following an acute episode of gastroenteritis, were sent a questionnaire about their current bowel habits and physical and mental health six years after their initial illness. Results: Complete data on original bowel habit, episodes of gastroenteritis, mental health history, and subsequent bowel habit at six years were obtained in 192 individuals. Of these, there were 14 cases of "post-infective IBS" (PI-IBS) and 13 who had IBS prior to infection (previous IBS). Over the six year follow up period there were 20 "new non-infective IBS cases" (new IBS). The strongest risk factor for developing any type of IBS was female sex (relative risk 2.2, p<0.05). Compared with new IBS, those with PI-IBS had significantly more days with loose stools (p<0.05) but a similar number of days with pain, urgency, and bloating. Six of 14 (43%) PI-IBS and four of 13 (31%) previous IBS patients recovered by six years (NS). Of 27 IBS patients followed for six years, only 1/8 with a history of anxiety or depression recovered compared with 9/19 without such a history (p=0.19). Conclusion: PI-IBS differs from non-infective IBS by having more diarrhoeal features. Less than half of both PI-IBS and non-infective IBS cases recover over six years. A history of anxiety and depression severe enough to warrant treatment may impair recovery but larger numbers are needed to prove this.

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

“…These results are generally consistent with those of previous long-term studies. [20][21][22] Additionally, we found that the long-term natural course of PI-IBS was similar to that of sporadic IBS in our cohort. Although we found a slightly higher incidence of IBS in the Shigella-exposed group than the control group at 5 and 8 years post-outbreak, the differences were not statistically significant.…”

“…[20][21][22] Among these relatively long-term reports, one is a 6-year follow-up study from a British cohort, 20 another is a 5-year follow-up study from a Swedish cohort, 21 and the other is an 8-year follow-up study from a Canadian cohort. 22 However, our study followed Korean patients for 10 years, and as such is the longest follow-up study concerning PI-IBS.…”

“…12 Although there have been many reports regarding PI-IBS associated with pathogens such as Shigella spp., pathogenic Escherichia coli, Salmonella, Campylobacter jejuni, and Giardia duodenalis in the past 20 years, [13][14][15][16][17][18][19] most of these reports address the shortterm clinical course of PI-IBS, and only few examined the longterm course (≥ 5 years) of PI-IBS. [20][21][22][23] We previously reported on the clinical course of PI-IBS in a homogenous cohort comprised of patients recovered from shigellosis. 17,23,24 In the current study, we report on the collective results of a 10-year, long-term follow-up of our small, well-followed, homogenous cohort of patients that developed PI-IBS after shigellosis.…”

Treatment of postinfectious irritable bowel syndrome and noninfective irritable bowel syndrome with mesalazine

“…Patients who develop IBS show increased numbers of EC, and lymphocyte cell counts at 3 months compared to those who do not develop IBS (18,25) . Individuals with PI-IBS are a clinically distinct subgroup characterized by diarrheal symptoms, less psychiatric illness, and increased serotonin-containing EC compared to those with non-PI-IBS (8) .…”

Postinfectious Chronic Gut Dysfunction: From Bench to Bedside

“…A subsequent, larger study conducted by Neal et al Postinfectious IBS can persist for the long term following an episode of bacterial gastroenteritis. In two long-term follow-up studies, less than half of postinfectious IBS cases recovered at 5 to 6 years ( 11,12 ). In a follow-up study of patients who developed acute gastroenteritis during a large outbreak in 2000, the prevalence of IBS at 8 years was 15.4 % (compared with a 28.3 % prevalence 2 to 3 years aft er the outbreak) and remained signifi cantly increased compared with controls who did not have acute gastroenteritis (odds ratio, 3.12; 95 % confi dence interval 1.99 -5.04) ( 13 ).…”