Rome Foundation Working Team Report on Post-Infection Irritable Bowel Syndrome

Abstract

Background & Aims The existence of post-infection irritable bowel syndrome (PI-IBS) has been substantiated by epidemiology studies conducted in diverse geographic and clinical settings. However, the available evidence has not been well summarized and there is little guidance for diagnosis and treatment of PI-IBS. The ROME Foundation has produced a working team report was to summarize the available evidence on the pathophysiology of PI-IBS and provide guidance for diagnosis and treatment, based upon findings reported in the literature and clinical experience. Methods The working team conducted an evidence-based review of publication databases for articles describing the clinical features (diagnosis), pathophysiology (intestinal sensorimotor function, microbiota, immune dysregulation, barrier dysfunction, enteroendocrine pathways and genetics), and animal models of PI-IBS. We used a Delphi-based consensus system to create guidelines for management of PI-IBS and a developed treatment algorithm based on published findings and experiences of team members. Results PI-IBS develops in about 10% of patients with infectious enteritis. Risk factors include female sex, younger age, psychological distress during or prior to acute gastroenteritis, and severity of the acute episode. The pathogenesis of PI-PBS appears to involve changes in the intestinal microbiome as well as epithelial, serotonergic, and immune system factors. However, these mechanisms are incompletely understood. There is no evidence- based effective pharmacologic strategies for treatment of PI-IBS. We provide a consensus-based treatment algorithm, based on clinical presentation and potential disease mechanisms. Conclusions Based on a systematic review of the literature and team experience, we summarize the clinical features, pathophysiology (from animal models and human studies), and progression of PI-IBS. Based on these findings, we present an algorithm for diagnosis and treatment of PI-IBS based upon team consensus. We also propose areas for investigations.

Functional gastrointestinal disorders in women with systemic lupus erythematosus: A case‐control study

“…Another potential explanation for the higher frequency of FGIDs in SLE patients may be that these patients may be immunosuppressed, which could predispose them to enteric infections . The role of gastrointestinal infections as trigger factors for postinfection disorders such as IBS has been described . However, the actual frequency of enteric infections in patients with SLE is unknown.…”

“…32 The role of gastrointestinal infections as trigger factors for postinfection disorders such as IBS has been described. 33…”

Post-infection irritable bowel syndrome in the tropical and subtropical regions: Vibrio cholerae is a new cause of this well-known condition

“…PI-IBS patients have the inability to restore the microbial ecosystem after an attack of acute gastroenteritis [1]. The significant difference in gut microbiota profile of PI-IBS patients compared with healthy control has been found [62,63].…”

“…Although studies on PI-IBS provide us probably the best evidence for a micro-organic basis of this hitherto enigmatic disorder, the pathophysiological mechanisms of PI-IBS have not been studied much. Current evidence suggests that PI-IBS is complex and is probably a multifactorial disease involving visceral hypersensitivity, gut dysmotility, microbial dysbiosis, altered intestinal permeability, immune dysregulation, alteration in neuroendocrine pathways, and genetic factors [1,51,52]. Gut microbiota dysbiosis is associated with acute gastroenteritis, its recovery, and development of PI-IBS [53,54].…”

Editorial

“…No es casualidad que quizá el grupo más reconocido internacionalmente en el estudio de este subgrupo de SII sea quien revise el tema 12 . Según la revisión de los autores, el SII-PI presenta una incidencia del 3 al 30%, con una prevalencia acumulada que va del 10.1% a los 12 meses luego de la gastroenteritis, hasta el 14.5% luego del año de esta 12 . Este es un primer aspecto importante que vale la pena contrastar con lo que ocurre en Latinoamérica, donde tenemos escasos estudios a este respeto, y algunas evidencias de México, que sugieren que el SII-PI tiene una baja prevalencia con respecto a lo que ocurre en otros lugares del mundo, alrededor del 5% 13 .…”