Half of the patients develop prolonged irritable bowel syndrome after gastroenteritis

TOP LINE:

Acute gastroenteritis increases the likelihood of developing functional dyspepsia (FD) or irritable bowel syndrome (IBS). In half of the patients, irritable bowel syndrome persists 1–4 years after infection.

METHODOLOGY:

Disorders of the gut-brain interaction such as irritable bowel syndrome and FD can occur after acute infectious gastroenteritis, but data on their prevalence and persistence after infection as well as the influence of the pathogen type are lacking.
Researchers conducted a systematic review and meta-analysis of 47 observational studies examining the prevalence of post-infectious IBS (PI-IBS) or post-infectious FD (PI-FD) after acute gastroenteritis.
28,170 participants from 27 countries took part in the studies. Only studies with a follow-up period of at least 3 months were included.
The research team used a random effects model to estimate the prevalence and odds ratios (ORs) of PI-IBS and PI-FD.

TAKE AWAY:

Overall, 14.5% of participants with acute gastroenteritis developed PI-IBS and 12.7% developed PI-FD.
Patients with acute gastroenteritis were 4.3 times more likely to have PI-IBS and three times more likely to have PI-FD than unexposed controls.
PI-IBS rates persisted in 52.3% of participants after 1–4 years of follow-up and in 39.8% after more than 5 years. There were insufficient data to determine the persistence of FD.
PI-IBS was most commonly associated with parasites (prevalence 30.1%), followed by bacteria (18.3%) and viruses (10.7%).
In available studies Campylobacter was associated with the highest PI-IBS prevalence (20.7%), although Proteobacteria and SARS-CoV-2 had the highest odds of PI-IBS (OR, 5.4 for both). The prevalence of PI-FD was 10% for SARS-CoV-2 and 13.6% for Bacteria, with the highest prevalence after Enterobacteriaceae Infection (19.4%).

IN PRACTICE:

“Because acute gastroenteritis is a common disease worldwide, our findings may have public health relevance. Physicians should be alert if their patients have had a recent history of infectious gastroenteritis,” the authors wrote. “In addition, physicians should be aware that some microbes with pro-inflammatory properties may be associated with PI-IBS or PI-FD.”

SOURCE:

The study with lead author Serena Porcari from the Department of Translational Medicine and Surgery at the Universita Cattolica del Sacro Cuore Facolta di Medicina e Chirurgie in Rome was published online in Colon.

RESTRICTIONS:

The study was limited by the heterogeneity of study designs, definitions of inflammatory bowel disease and FD, sample sizes, and length of follow-up periods. In addition, most studies were from Europe and North America, with limited data from areas with high prevalence of acute gastroenteritis, such as the Asia-Pacific region and Africa.

DISCLOSURE:

The study was supported by the Fondazione Roma, the Italian Ministry of Health, the Italian Ministry of Universities and Research, and the Italian Ministry of Research. Several authors reported consulting, speaking, and expert fees from numerous pharmaceutical companies.