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01-04-2019 | Acute Gastroenteritis | Technical Notes
Post-infection irritable bowel syndrome in the tropical and subtropical regions: Vibrio cholerae is a new cause of this well-known condition
Published in: Indian Journal of Gastroenterology | Issue 2/2019
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Following acute infective gastroenteritis, 4% to 37% of patients develop new-onset persistent bowel symptoms fulfilling the Rome criteria for irritable bowel syndrome (IBS), an entity recently named as post-infection IBS (PI-IBS) [1]. The acute episode of gastroenteritis should fulfill at least two of the four criteria, namely diarrhea, fever, vomiting, and positive stool culture. PI-IBS develops mostly following acute infectious diarrhea due to multiple etiological agents, more so due to invasive pathogens (Table 1). However, a few studies did report the occurrence of PI-IBS following infection due to less invasive pathogens causing diarrhea such as viruses [19, 22]. Hence, the conventional belief that the PI-IBS occurs predominantly following acute gastroenteritis due to invasive pathogen is no more tenable. Moreover, two recent studies, one from Bangladesh and another one published in this issue of the Journal from India, showed the occurrence of PI-IBS following infection with Vibrio cholerae (V. cholerae), conventionally known as a noninvasive pathogen, challenging this belief further [27, 28].
Table 1
Incidence, etiology of acute gastroenteritis, and risk factors for post-infection irritable bowel syndrome in cases and controls
|
Study details
|
Country
|
Cause of gastroenteritis
|
IBS in cases (%)
|
IBS in controls
|
Risk factors for post-infection IBS
|
|---|---|---|---|---|---|
|
McKendrick and Read (1994) [2]
|
UK
|
Salmonella
|
12/38 (31.6)
|
No control
|
Severity of acute illness, vomiting, and weight loss
|
|
Gwee et al. (1996) [3]
|
UK
|
Shigella, Campylobacter, Salmonella
|
20/75 (26.6)
|
No control
|
Anxiety, depression, somatisation, and neurotic trait
|
|
Neal et al. (1997) [4]
|
UK
|
Bacteria
|
23/347 (6.6)
|
No control
|
Longer duration of diarrhea, younger age, and female sex
|
|
Gwee et al. (1999) [5]
|
UK
|
–
|
19/109 (17.4)
|
Psychological and rectal biopsy: 21 HS
|
Psychological factors and persistent rectal inflammation
|
|
Rodriguez and Ruigomez (1999) [6]
|
UK
|
Bacteria
|
14/318 (4.4)
|
2027/584308 (0.3%)
|
Not evaluated
|
|
Mearin et al. (2005) [7]
|
Spain
|
Salmonella
|
13.2%
|
1.5%
|
No risk factor identified
|
|
Ilnyckyj et al. (2003) [8]
|
Canada
|
Traveler’s diarrhea
|
2/48 (4.2)
|
1/61 (1.6%)
|
Not evaluated
|
|
Dunlop et al. (2003) [9]
|
UK
|
Campylobacter
|
103/747 (13.8)
|
No control
|
Increased enterochromaffin cells in lamina propria and depression
|
|
Parry et al. (2003) [10]
|
UK
|
Campylobacter, Salmonella
|
18/108 (16.7)
|
4/219 (1.9%)
|
Not evaluated
|
|
Wang et al. (2004) [11]
|
China
|
Shigella
|
24/295 (8.1)
|
2/243 (0.8%)
|
Longer diarrhea, IL-1β mRNA expression, and mast cell in ileum and rectosigmoid
|
|
Okhuysen et al. (2004) [12]
|
USA
|
Traveler’s diarrhea
|
60 (6)
|
No control
|
More diarrhea, medical consultation, and stool negative for the pathogen
|
|
Ji et al. (2005) [13]
|
Korea
|
Shigellosis
|
15/101 (14.8)
|
6/102 (5.8%)
|
Diarrhea duration
|
|
Parry et al. (2005) [14]
|
UK
|
Bacteria
|
16/107 (15)
|
No control
|
Smoking
|
|
Kim et al. (2006) [15]
|
Korea
|
Shigella
|
13/95 (13.6)
|
4/105 (3.8%)
|
Pre-existing FBD other than IBS
|
|
Marshall et al. (2006) [16]
|
Canada
|
E. coli, Campylobacter
|
417/1368 (30.5)
|
71/701 (10.2%)
|
Young age, female, bloody stools, weight loss, and long diarrhea
|
|
Borgaonkar et al. (2006) [17]
|
Canada
|
Bacteria
|
7/191 (3.7)
|
No control
|
Fever during gastroenteritis
|
|
Stermer et al. (2006) [18]
|
Israel
|
Traveler’s diarrhea
|
16/118 (13.6)
|
7/287 (2.4%)
|
Female gender, abdominal pain, prolonged diarrhea, and antibiotic use
|
|
Marshall et al. (2007) [19]
|
Canada
|
Viral diarrhea
|
21/89 (23.6)
|
1/29 (3.4%)
|
Vomiting during gastroenteritis
|
|
Spence et al. (2007) [20]
|
New Zealand
|
Campylobacter
|
86/581 (14.8)
|
No control
|
Psychological co-morbidity and lack or rest during gastroenteritis
|
|
Hanevik et al. (2009) [21]
|
Norway
|
Giardia
|
66/82 (80.5)
|
No control
|
Not evaluated
|
|
Zanini et al. (2012) [22]
|
Italy
|
Norovirus
|
40/186 (21.5)
|
3/198 (1.5%)
|
Not evaluated
|
|
Cremon et al. (2014) [23]
|
Italy
|
Salmonella enterica subsp. enterica serovar Typhi
|
75/204 (36.8)
|
44/189 (23.3%)
|
Anxiety and functional dyspepsia
|
|
Persson et al. (2015) [24]
|
Norway
|
Giardia
|
224/724 (32)
|
96/847 (11.4%)
|
Not evaluated
|
|
Wadhwa et al. (2016) [25]
|
USA
|
Clostridium difficile
|
52/205 (25)
|
No control
|
Longer infection duration, current anxiety, and higher BMI
|
|
Andresen et al. (2016) [26]
|
Germany
|
Shiga-like toxin-producing E. coli
|
98/389 (25.3)
|
No control
|
Higher somatization and anxiety scores
|
|
Rahman and Ghoshal (2018) [27]
|
Bangladesh
|
E. coli, Campylobacter V. Cholera, Salmonella, Shigella, Aeromonas
|
57/345 (16.5)
|
9/345 (2.6%)
|
Dyspeptic symptoms, continuing bowel dysfunction, and weight loss
|
|
Current study (2019) [28]
|
India
|
E. coli, Campylobacter V. Cholerae, Salmonella, Shigella, Y. enterocolitica
|
35/136 (25.7)
|
No control
|
Younger age, prolonged duration of diarrhea, and abdominal cramps
|