Skip to main content

Advertisement

Log in

Post-Infectious Irritable Bowel Syndrome

  • Neurogastroenterology and Motility Disorders of the Gastrointestinal Tract (S Rao, Section Editor)
  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Post-infectious irritable bowel syndrome (PI-IBS) is characterized by persistent abdominal pain and diarrhea, typically following an episode of infectious gastroenteritis. The mechanisms that underlie IBS-D remain elusive, but PI-IBS provides a mechanistic model of this disorder. This review provides an up-to-date appraisal of the pathophysiology, clinical features, and management approaches for PI-IBS.

Recent Findings

Disordered immune reactions and release of cytokines with resultant gut inflammation and dysfunction appear to be key features of PI-IBS. Disordered brain-gut-microbiota interactions, type of infecting agent, and host-genetic susceptibility are risk factors but also are reasons for the varying spectrum of clinical severity. Although prognosis is generally good, symptoms and inflammation may persist for a long time. Symptomatic relief with antidiarrheals, antispasmodics, 5HT3 antagonists, mesalamine, probiotics, and low-dose antidepressants remain the primary approaches, but in some difficult cases, a combination of drugs that target the pathophysiology may be helpful.

Summary

PI-IBS has many overlapping features with IBS-D and shares similar pathophysiology and management approaches.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Thabane M, Marshall JK. Post-infectious irritable bowel syndrome. World J Gastroenterol. 2009;15:3591–6.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Dunlop SP, Jenkins D, Spiller RC. Distinctive clinical, psychological, and histological features of post-infective irritable bowel syndrome. Am J Gastroenterol. 2003;98:1578–83.

    Article  PubMed  Google Scholar 

  3. Chaudhary NA, Truelove SC. The irritable colon syndrome: a study of the clinical features, predisposing causes, and prognosis in 130 cases. Q J Med. 1962;31:307–22.

    CAS  PubMed  Google Scholar 

  4. •• Marshall JK, Thabane M, Garg AX, Clark WF, Salvadori M, Collins S. Incidence and epidemiology of irritable bowel syndrome after a large waterborne outbreak of bacterial dysentery. Gastroenterology. 2006;131:445–50. This is considered to many as the landmark study of post-infectious IBS.

    Article  PubMed  Google Scholar 

  5. Borgaonkar MR, Ford DC, Marshall JK, Churchill E, Collins SM. The incidence of irritable bowel syndrome among community subjects with previous acute enteric infection. Dig Dis Sci. 2006;51:1026–32.

    Article  PubMed  Google Scholar 

  6. Ilnyckyj A, Balachandra B, Elliott L, Choudhri S, Duerksen DR. Post-traveler’s diarrhea irritable bowel syndrome: a prospective study. Am J Gastroenterol. 2003;98:596–9.

    Article  PubMed  Google Scholar 

  7. Okhuysen PC, Jiang ZD, Carlin L, Forbes C, DuPont HL. Post-diarrhea chronic intestinal symptoms and irritable bowel syndrome in north American travelers to Mexico. Am J Gastroenterol. 2004;99:1774–8.

    Article  PubMed  Google Scholar 

  8. Rodríguez LAG, Ruigómez A. Increased risk of irritable bowel syndrome after bacterial gastroenteritis: cohort study. BMJ. 1999;318:565–6.

    Article  PubMed  PubMed Central  Google Scholar 

  9. McKendrick M, Read N. Irritable bowel syndrome—post salmonella infection. J Inf Secur. 1994;29:1–3.

    CAS  Google Scholar 

  10. Mearin F, Badia X, Balboa A, Baró E, Caldwell E, Cucala M, et al. Irritable bowel syndrome prevalence varies enormously depending on the employed diagnostic criteria: comparison of Rome II versus previous criteria in a general population. Scand J Gastroenterol. 2001;36:1155–61.

    Article  CAS  PubMed  Google Scholar 

  11. Stermer E, Lubezky A, Potasman I, Paster E, Lavy A. Is traveler’s diarrhea a significant risk factor for the development of irritable bowel syndrome? A prospective study. Clin Infect Dis. 2006;43:898–0.

    Article  PubMed  Google Scholar 

  12. Kim HS, Kim MS, Ji SW, Park H. The development of irritable bowel syndrome after Shigella infection: 3 year follow-up study. Korean J Gastroenterol. 2006;47:300–5.

    PubMed  Google Scholar 

  13. Moss-Morris R, Spence M. To “lump” or to “split” the functional somatic syndromes: can infectious and emotional risk factors differentiate between the onset of chronic fatigue syndrome and irritable bowel syndrome? Psychosom Med. 2006;68:463–9.

    Article  PubMed  Google Scholar 

  14. Spence MJ, Moss-Morris R. The cognitive behavioural model of irritable bowel syndrome: a prospective investigation of patients with gastroenteritis. Gut. 2007;56:1066–71.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Wang L, Fang X, Pan G. Bacillary dysentery as a causative factor of irritable bowel syndrome and its pathogenesis. Gut. 2004;53:1096–101.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Halvorson HA, Schlett CD, Riddle MS. Postinfectious irritable bowel syndrome—a meta-analysis. Am J Gastroenterol. 2006;101:1894–9.

    Article  PubMed  Google Scholar 

  17. Thabane M, Kottachchi D, Marshall J. Systematic review and meta-analysis: the incidence and prognosis of post-infectious irritable bowel syndrome. Aliment Pharmacol Ther. 2007;26:535–44.

    Article  CAS  PubMed  Google Scholar 

  18. Thabane M, Simunovic M, Akhtar-Danesh N, Garg AX, Clark WF, Collins SM, et al. An outbreak of acute bacterial gastroenteritis is associated with an increased incidence of irritable bowel syndrome in children. Am J Gastroenterol. 2010;105:933–9.

    Article  PubMed  Google Scholar 

  19. Mutsch M, Pitzurra R, Hatz C, Steffen R. Post-infectious Sequelae of Travelers' diarrhea: irritable bowel syndrome. J Travel Med. 2014;21:141–3.

    Article  PubMed  Google Scholar 

  20. Lee YY, Rao SC. Post-infectious irritable bowel syndrome. Biota-Scope 2015;2:10–6.

  21. •• Lawenko RMA, Lee YY, Nurfadhilah Y, Yaacob N, Mohammad WMZW, Liong MT, et al. The role of gut dysbiosis and probiotics in persistent abdominal pain following a major flood disaster. J Gastroenterol Hepatol. 2016;31:131. This study provides evidence for IBS akin to post-infectious IBS following a major disaster and that probiotic is useful in such a situation.

    Google Scholar 

  22. Neal K, Hebden J, Spiller R. Prevalence of gastrointestinal symptoms six months after bacterial gastroenteritis and risk factors for development of the irritable bowel syndrome: postal survey of patients. BMJ. 1997;314:779–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Ibarra C, Herrera V. Pérez dAE, Gil L, Madrid A, Valenzuela L, et al. Parasitosis and irritable bowel syndrome. Rev Chil Infectol. 2016;33:268–74.

    Article  Google Scholar 

  24. Motomura Y, Khan WI, El-Sharkawy RT, Verma-Gandhu M, Grencis RK, Collins SM. Mechanisms underlying gut dysfunction in a murine model of chronic parasitic infection. Am J Physiol Gastrointest Liver Physiol. 2010;299:G1354–60.

    Article  CAS  PubMed  Google Scholar 

  25. Beatty J, Bhargava A, Buret A. Post-infectious irritable bowel syndrome: mechanistic insights into chronic disturbances following enteric infection. World J Gastroenterol. 2014;20:3976–85.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Teoh DA, Kamieniecki D, Pang G, Buret AG. Giardia Lamblia rearranges F-actin and α-actinin in human colonic and duodenal monolayers and reduces transepithelial electrical resistance. J Parasitol. 2000;86:800–6.

    CAS  PubMed  Google Scholar 

  27. Hanevik K, Dizdar V, Langeland N, Hausken T. Development of functional gastrointestinal disorders after Giardia lamblia infection. BMC Gastroenterol. 2009;9:1–5.

    Article  Google Scholar 

  28. Buret AG. Pathophysiology of enteric infections with Giardia duodenalis. Parasite. 2008;15:261–5.

    Article  CAS  PubMed  Google Scholar 

  29. Long Y, Wang W, Wang H, Hao L, Qian W, Hou X. Characteristics of intestinal lamina propria dendritic cells in a mouse model of postinfectious irritable bowel syndrome. J Gastroenterol Hepatol. 2012;27:935–44.

    Article  CAS  PubMed  Google Scholar 

  30. Lupp C, Robertson ML, Wickham ME, Sekirov I, Champion OL, Gaynor EC, et al. Host-mediated inflammation disrupts the intestinal microbiota and promotes the overgrowth of Enterobacteriaceae. Cell Host Microbe. 2007;2:119–29.

    Article  CAS  PubMed  Google Scholar 

  31. •• Ghoshal UC, Gwee K-A. Post-infectious IBS, tropical sprue and small intestinal bacterial overgrowth: the missing link. Nat Rev Gastroenterol Hepatol. 2017;14:435–41. This review provides some thought provoking issues in relation to tropical sprue and how it is associated with post-infectious IBS

    Article  PubMed  Google Scholar 

  32. Malinen E, Rinttilä T, Kajander K, Mättö J, Kassinen A, Krogius L, et al. Analysis of the fecal microbiota of irritable bowel syndrome patients and healthy controls with real-time PCR. Am J Gastroenterol. 2005;100:373–82.

    Article  CAS  PubMed  Google Scholar 

  33. Krogius-Kurikka L, Lyra A, Malinen E, Aarnikunnas J, Tuimala J, Paulin L, et al. Microbial community analysis reveals high level phylogenetic alterations in the overall gastrointestinal microbiota of diarrhoea-predominant irritable bowel syndrome sufferers. BMC Gastroenterol. 2009;9:95.

    Article  PubMed  PubMed Central  Google Scholar 

  34. •• Jalanka-Tuovinen J, Salojärvi J, Salonen A, Immonen O, Garsed K, Kelly FM, et al. Faecal microbiota composition and host–microbe cross-talk following gastroenteritis and in postinfectious irritable bowel syndrome. Gut. 2014;63:1737–45. The faecal microbiota of patients with PI-IBS differ from that of healthy controls and resemble patients with IBS-D, suggesting a common pathophysiology.

    Article  PubMed  Google Scholar 

  35. Levy RL, Jones KR, Whitehead WE, Feld SI, Talley NJ, Corey LA. Irritable bowel syndrome in twins: heredity and social learning both contribute to etiology. Gastroenterology. 2001;121:799–804.

    Article  CAS  PubMed  Google Scholar 

  36. Spiller RC. Postinfectious irritable bowel syndrome. Gastroenterology. 2003;124:1662–71.

    Article  PubMed  Google Scholar 

  37. Van Der Veek PP, Van Den Berg M, De Kroon YE, Verspaget HW, Masclee AA. Role of tumor necrosis factor-α and interleukin-10 gene polymorphisms in irritable bowel syndrome. Am J Gastroenterol. 2005;100:2510–6.

    Article  PubMed  Google Scholar 

  38. Villani AC, Lemire M, Thabane M, Belisle A, Geneau G, Garg AX, et al. Genetic risk factors for post-infectious irritable bowel syndrome following a waterborne outbreak of gastroenteritis. Gastroenterology. 2010;138:1502–13.

    Article  CAS  PubMed  Google Scholar 

  39. Spiller RC, Jenkins D, Thornley JM, Hebden J, Wright T, Skinner M, et al. Increased rectal mucosal enteroendocrine cells, T lymphocytes, and increased gut permeability following acuteCampylobacter enteritis and in post-dysenteric irritable bowel syndrome. Gut. 2000;47:804–11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Keating C, Beyak M, Foley S, Singh G, Marsden C, Spiller R, et al. Afferent hypersensitivity in a mouse model of post-inflammatory gut dysfunction: role of altered serotonin metabolism. J Physiol. 2008;586:4517–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Barbara G, Wang B, Stanghellini V, De Giorgio R, Cremon C, Di Nardo G, et al. Mast cell-dependent excitation of visceral-nociceptive sensory neurons in irritable bowel syndrome. Gastroenterology. 2007;132:26–37.

    Article  CAS  PubMed  Google Scholar 

  42. Mearin F, Perelló A, Balboa A, Perona M, Sans M, Salas A, et al. Pathogenic mechanisms of postinfectious functional gastrointestinal disorders: results 3 years after gastroenteritis. Scand J Gastroenterol. 2009;44:1173–85.

    Article  CAS  PubMed  Google Scholar 

  43. Barbara G, Stanghellini V, De Giorgio R, Cremon C, Cottrell GS, Santini D, et al. Activated mast cells in proximity to colonic nerves correlate with abdominal pain in irritable bowel syndrome. Gastroenterology. 2004;126:693–702.

    Article  PubMed  Google Scholar 

  44. Park JH, Rhee PL, Kim HS, Lee JH, Kim YH, Kim JJ, et al. Mucosal mast cell counts correlate with visceral hypersensitivity in patients with diarrhea predominant irritable bowel syndrome. J Gastroenterol Hepatol. 2006;21:71–8.

    Article  PubMed  Google Scholar 

  45. Sundin J, Rangel I, Kumawat AK, Hultgren-Hörnquist E, Brummer RJ. Aberrant mucosal lymphocyte number and subsets in the colon of post-infectious irritable bowel syndrome patients. Scand J Gastroenterol. 2014;49:1068–75.

    Article  CAS  PubMed  Google Scholar 

  46. Sundin J, Rangel I, Fuentes S, Heikamp-de Jong I, Hultgren-Hörnquist E, Vos W, et al. Altered faecal and mucosal microbial composition in post-infectious irritable bowel syndrome patients correlates with mucosal lymphocyte phenotypes and psychological distress. Aliment Pharmacol Ther. 2015;41:342–51.

    Article  CAS  PubMed  Google Scholar 

  47. Gwee K, Collins S, Read N, Rajnakova A, Deng Y, Graham J, et al. Increased rectal mucosal expression of interleukin 1β in recently acquired post-infectious irritable bowel syndrome. Gut. 2003;52:523–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Ghoshal UC, Shukla R, Ghoshal U, Gwee K-A, Ng SC, Quigley EM. The gut microbiota and irritable bowel syndrome: friend or foe? Int J Inflam. 2012;2012:13.

    Article  Google Scholar 

  49. Lee YA, Nam YH, Min A, et al. Entamoeba histolytica-secreted cysteine proteases induce IL-8 production in human mast cells via a PAR2-independent mechanism. Parasite. 2014;21:1.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Clarke G, McKernan DP, Gaszner G, Quigley EM, Cryan JF, Dinan TG. Increased Kynurenine production following toll-like receptor (TLR) activation: a novel role for Tlr8 in irritable bowel syndrome (IBS). Gastroenterology. 2011;140(5):S-111.

    Google Scholar 

  51. Brint EK, MacSharry J, Fanning A, Shanahan F, Quigley EM. Differential expression of toll-like receptors in patients with irritable bowel syndrome. Am J Gastroenterol. 2011;106(2):329–36.

    Article  CAS  PubMed  Google Scholar 

  52. Belmonte L, Youmba SB, Bertiaux-Vandaele N, Antonietti M, Lecleire S, Zalar A, et al. Role of toll like receptors in irritable bowel syndrome: differential mucosal immune activation according to the disease subtype. PLoS One. 2012;7:e42777.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Hansson GC. Role of mucus layers in gut infection and inflammation. Curr Opin Microbiol. 2012;15:57–62.

    Article  CAS  PubMed  Google Scholar 

  54. Faure M, Moënnoz D, Montigon F, Mettraux C, Breuillé D, Ballèvre O. Dietary threonine restriction specifically reduces intestinal mucin synthesis in rats. J Nutr. 2005;135:486–91.

    CAS  PubMed  Google Scholar 

  55. Kashyap PC, Marcobal A, Ursell LK, Smits SA, Sonnenburg ED, Costello EK, et al. Genetically dictated change in host mucus carbohydrate landscape exerts a diet-dependent effect on the gut microbiota. Proc Natl Acad Sci U S A. 2013;110:17059–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Simpson J, Sundler F, Humes D, Jenkins D, Wakelin D, Scholefield J, et al. Prolonged elevation of galanin and tachykinin expression in mucosal and myenteric enteric nerves in trinitrobenzene sulphonic acid colitis. Neurogastroenterol Motil. 2008;20:392–406.

    Article  CAS  PubMed  Google Scholar 

  57. Akbar A, Yiangou Y, Facer P, Walters JR, Anand P, Ghosh S. Increased capsaicin receptor TRPV1-expressing sensory fibres in irritable bowel syndrome and their correlation with abdominal pain. Gut. 2008;57:923–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Törnblom H, Lindberg G, Nyberg B, Veress B. Full-thickness biopsy of the jejunum reveals inflammation and enteric neuropathy in irritable bowel syndrome. Gastroenterology. 2002;123:1972–9.

    Article  PubMed  Google Scholar 

  59. Gwee KA, Lu CL, Ghoshal UC. Epidemiology of irritable bowel syndrome in Asia: something old, something new, something borrowed. J Gastroenterol Hepatol. 2009;24:1601–7.

    Article  PubMed  Google Scholar 

  60. Wouters MM, Van Wanrooy S, Nguyen A, Dooley J, Aguilera-Lizarraga J, Van Brabant W, et al. Psychological comorbidity increases the risk for postinfectious IBS partly by enhanced susceptibility to develop infectious gastroenteritis. Gut. 2016;65:1279–88.

    Article  PubMed  Google Scholar 

  61. Kiank C, Taché Y, Larauche M. Stress-related modulation of inflammation in experimental models of bowel disease and post-infectious irritable bowel syndrome: role of corticotropin-releasing factor receptors. Brain Behav Immun. 2010;24:41–8.

    Article  CAS  PubMed  Google Scholar 

  62. Clarke G, Cryan J, Dinan T, Quigley EM. Probiotics for the treatment of irritable bowel syndrome–focus on lactic acid bacteria. Aliment Pharmacol Ther. 2012;35:403–13.

    Article  CAS  PubMed  Google Scholar 

  63. Huang JS, Bousvaros A, Lee JW, Diaz A, Davidson EJ. Efficacy of probiotic use in acute diarrhea in children: a meta-analysis. Dig Dis Sci. 2002;47:2625–34.

    Article  CAS  PubMed  Google Scholar 

  64. O’Mahony L, McCarthy J, Kelly P, Hurley G, Luo F, Chen K, et al. Lactobacillus and bifidobacterium in irritable bowel syndrome: symptom responses and relationship to cytokine profiles. Gastroenterology. 2005;128:541–51.

    Article  PubMed  Google Scholar 

  65. Cuomo R, Savarese MF, Gargano R. Almost all irritable bowel syndromes are post-infectious and respond to probiotics: consensus issues. Dig Dis. 2007;25:241–4.

    Article  PubMed  Google Scholar 

  66. Verdu EF, Bercik P, Verma-Gandhu M, Huang X-X, Blennerhassett P, Jackson W, et al. Specific probiotic therapy attenuates antibiotic induced visceral hypersensitivity in mice. Gut. 2006;55:182–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  67. Parry SD, Barton JR, Welfare MR. Factors associated with the development of post-infectious functional gastrointestinal diseases: does smoking play a role? Eur J Gastroenterol Hepatol. 2005;17:1071–5.

    Article  PubMed  Google Scholar 

  68. Lee YY, Waid A, Tan HJ, Chua AS, Whitehead WE. Rome III survey of irritable bowel syndrome among ethnic Malays. World J Gastroenterol. 2012;18:6475–80.

    Article  PubMed  PubMed Central  Google Scholar 

  69. McCarroll MG, Riddle MS, Gutierrez RL, Porter CK. Infectious gastroenteritis as a risk factor for tropical Sprue and Malabsorption: a case–control study. Dig Dis Sci. 2015;60:3379–85.

    Article  PubMed  Google Scholar 

  70. David L-E, Surdea-Blaga T, Dumitrascu D-L. Semiquantitative fecal calprotectin test in postinfectious and non-postinfectious irritable bowel syndrome: cross-sectional study. Sao Paulo Med J. 2015;133:343–9.

    Article  PubMed  Google Scholar 

  71. Pimentel M, Morales W, Rezaie A, Marsh E, Lembo A, Mirocha J, et al. Development and validation of a biomarker for diarrhea-predominant irritable bowel syndrome in human subjects. PLoS One. 2015;10:e0126438.

    Article  PubMed  PubMed Central  Google Scholar 

  72. •• Marshall J, Thabane M, Garg A, Clark W, Moayyedi P, Collins S. Walkerton health study investigators. Eight year prognosis of postinfectious irritable bowel syndrome following waterborne bacterial dysentery. Gut. 2010;59:605–11. This study provides data on prognosis of post-infectious IBS for eight years.

    Article  PubMed  Google Scholar 

  73. • Abdul Rani R, Ali R, Affendi R, Lee YY. Irritable bowel syndrome and inflammatory bowel disease overlap syndrome: pieces of the puzzle are falling into place. Intest Res. 2016;14:297–304. Both IBD and IBS have significant overlap in terms of symptoms, pathophysiology, and treatment, suggesting the possibility of IBS and IBD being a single disease entity albeit at opposite ends of the spectrum.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Hilmi I, Hartono JL, Pailoor J, Mahadeva S, Goh K-L. Low prevalence of ‘classical’microscopic colitis but evidence of microscopic inflammation in Asian irritable bowel syndrome patients with diarrhoea. BMC Gastroenterol. 2013;13:80.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Porter CK, Cash BD, Pimentel M, Akinseye A, Riddle MS. Risk of inflammatory bowel disease following a diagnosis of irritable bowel syndrome. BMC Gastroenterol. 2012;12:55.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Efskind P, Bernklev T, Vatn M. A double-blind placebo-controlled trial with loperamide in irritable bowel syndrome. Scand J Gastroenterol. 1996;31(5):463–8.

    Article  CAS  PubMed  Google Scholar 

  77. Drossman DA, Toner BB, Whitehead WE, Diamant NE, Dalton CB, Duncan S, et al. Cognitive-behavioral therapy versus education and desipramine versus placebo for moderate to severe functional bowel disorders. Gastroenterology. 2003;125:19–31. Epub 2003/07/10

    Article  PubMed  Google Scholar 

  78. Corinaldesi R, Stanghellini V, Cremon C, Gargano L, Cogliandro R, De Giorgio R, et al. Effect of mesalazine on mucosal immune biomarkers in irritable bowel syndrome: a randomized controlled proof-of-concept study. Aliment Pharmacol Ther. 2009;30:245–52.

    Article  CAS  PubMed  Google Scholar 

  79. Andrews C, Griffiths T, Kaufman J, Vergnolle N, Surette M, Rioux K. Mesalazine (5- aminosalicylic acid) alters faecal bacterial profiles, but not mucosal proteolytic activity in diarrhoea- predominant irritable bowel syndrome. Aliment Pharmacol Ther. 2011;34(3):374–83.

    Article  CAS  PubMed  Google Scholar 

  80. Lam C, Tan W, Leighton M, Hastings M, Lingaya M, Falcone Y, et al. A mechanistic multicentre, parallel group, randomised placebo-controlled trial of mesalazine for the treatment of IBS with diarrhea (IBS-D). Gut. 2016;65:91–9.

    Article  CAS  PubMed  Google Scholar 

  81. Erdogan A, Rao SS, Gulley D, Jacobs C, Lee YY, Badger C. Small intestinal bacterial overgrowth: duodenal aspiration vs glucose breath test. Neurogastroenterol Motil. 2015;27:481–9.

    Article  CAS  PubMed  Google Scholar 

  82. Sharara AI, Aoun E, Abdul-Baki H, Mounzer R, Sidani S, Elhajj. A randomized double-blind placebo-controlled trial of rifaximin in patients with abdominal bloating and flatulence. I. A C. Am J Gastroenterol. 2006; 101:326.

  83. •• Pimentel M, Lembo A, Chey WD, Zakko S, Ringel Y, Yu J, et al. Rifaximin therapy for patients with irritable bowel syndrome without constipation. N Engl J Med. 2011;364:22–32. In this landmark trial, rifaximin has been shown to be effective in IBS-D and possibility post-infectious IBS too.

    Article  CAS  PubMed  Google Scholar 

  84. Lembo A, Pimentel M, Rao SS, Schoenfeld P, Cash B, Weinstock LB, et al. Repeat treatment with Rifaximin is safe and effective in patients with diarrhea-predominant irritable bowel syndrome. Gastroenterology. 2016;151:1113–21.

    Article  CAS  PubMed  Google Scholar 

  85. Krause R, Ameen V, Gordon SH, West M, Heath AT, Perschy T, et al. A randomized, double-blind, placebo-controlled study to assess efficacy and safety of 0.5 Mg and 1 mg alosetron in women with severe diarrhea-predominant IBS. Am J Gastroenterol. 2007;102:1709.

    Article  CAS  PubMed  Google Scholar 

  86. Fukudo S, Ida M, Akiho H, et al. Effect of ramosetron on stool consistency in male patients with irritable bowel syndrome with diarrhea. Clin Gastroenterol Hepatol. 2014;12:953–9.

    Article  CAS  PubMed  Google Scholar 

  87. Fukudo S, Kinoshita Y, Okumura T, Ida M, Akiho H, Nakashima Y, et al. Ramosetron reduces symptoms of irritable bowel syndrome with diarrhea and improves quality of life in women. Gastroenterology. 2016;150:358–66.e8.

    Article  CAS  PubMed  Google Scholar 

  88. Garsed K, Chernova J, Hastings M, Lam C, Marciani L, Singh G, et al. A randomised atrial of ondansetron for the treatment of irritable bowel syndrome with diarrhoea. Gut. 2014;63:1617–25.

    Article  CAS  PubMed  Google Scholar 

  89. • Zheng Y, Yu T, Tang Y, Xiong W, Shen X, Jiang L, et al. Efficacy and safety of 5-hydroxytryptamine 3 receptor antagonists in irritable bowel syndrome: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2017;12:e0172846. Ramosetron, cilansetron, ondansetron, and alosetron are effective for treating non-constipated IBS and IBS-D. This systematic review found only rare serious adverse events associated with these drugs.

    Article  PubMed  PubMed Central  Google Scholar 

  90. Abbas Z, Yakoob J, Jafri W, Ahmad Z, Azam Z, Usman MW, et al. Cytokine and clinical response to saccharomyces boulardii therapy in diarrhea-dominant irritable bowel syndrome: a randomized trial. Eur J Gastroenterol Hepatol. 2014;26:630–9.

    Article  CAS  PubMed  Google Scholar 

  91. Symons P, Jones M, Kellow J. Symptom provocation in irritable bowel syndrome effects of differing doses of fructose-sorbitol. Scand J Gastroenterol. 1992;27:940–4.

    Article  CAS  PubMed  Google Scholar 

  92. Goldstein R, Braverman D, Stankiewicz H. Carbohydrate malabsorption and the effect of dietary restriction on symptoms of irritable bowel syndrome and functional bowel complaints. Isr Med Assoc J. 2000;2:583–7.

    CAS  PubMed  Google Scholar 

  93. Barrett JS, Gibson PR. Fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) and nonallergic food intolerance: FODMAPs or food chemicals? Therap Adv Gastroenterol. 2012;5:261–8.

    Article  PubMed  PubMed Central  Google Scholar 

  94. Marsh A, Eslick EM, Eslick GD. Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis. Eur J Nutr. 2016;55:897–906.

    Article  CAS  PubMed  Google Scholar 

  95. Ruepert L, Quartero AO, de Wit NJ, van der Heijden GJ, Rubin G, Muris JWM. Bulking agents, antispasmodics and antidepressants for the treatment of irritable bowel syndrome. Cochrane Database of Syst Rev. 2011;8:CD003460.

    Google Scholar 

  96. Khanna R, MacDonald JK, Levesque BG. Peppermint oil for the treatment of irritable bowel syndrome: a systematic review and meta-analysis. J Clin Gastroenterol. 2014;48:505–12.

    PubMed  Google Scholar 

  97. Dove LS, Lembo A, Randall CW, Fogel R, Andrae D, Davenport JM, et al. Eluxadoline benefits patients with irritable bowel syndrome with diarrhea in a phase 2 study. Gastroenterology. 2013;145:329–38.

    Article  CAS  PubMed  Google Scholar 

  98. Ford AC, Moayyedi P, Lacy BE, Lembo AJ, Saito YA, Schiller LR, et al. American College of Gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation. Am J Gastroenterol. 2014;109:S2–26.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by the Fundamental Research Grant Scheme of Ministry of Education of Malaysia (reference: 203.PPSP.6171183 and 203.PPSP.6171192).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Satish S. C. Rao.

Ethics declarations

Conflict of Interest

Yeong Yeh Lee, Chandramouli Annamalai, and Satish S. C. Rao declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Neurogastroenterology and Motility Disorders of the Gastrointestinal Tract

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, Y.Y., Annamalai, C. & Rao, S.S.C. Post-Infectious Irritable Bowel Syndrome. Curr Gastroenterol Rep 19, 56 (2017). https://doi.org/10.1007/s11894-017-0595-4

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11894-017-0595-4

Keywords

Navigation