Current Gastroenterology Reports

, Volume 9, Issue 5, pp 378–384 | Cite as

Post-infectious irritable bowel syndrome

  • Andrew W. DuPontEmail author


Irritable bowel syndrome (IBS) is a common disorder associated with abdominal pain or discomfort and altered bowel habits. The majority of patients describe an insidious onset of symptoms; however, a subset report a fairly precise time of onset following an attack of acute gastroenteritis. Typically, the potential acute infectious symptoms, such as fever and vomiting, resolve after several days, but abdominal discomfort, bloating, and diarrhea persist. Although the underlying mechanism of post-infectious IBS (PI-IBS) has not been established, ongoing inflammation appears to play a role, with an increase in serotonin-containing enterochromaffin cells, T lymphocytes, mast cells, proinflammatory cytokines, and intestinal permeability. Psychiatric comorbidities are less common in PI-IBS, compared with IBS patients in general; however, the prevalence of psychological disorders is still higher compared with that in the general population and is associated with a poorer prognosis. Overall, patients with PI-IBS have a slightly improved prognosis compared with those with IBS without an infectious onset.


Irritable Bowel Syndrome Gastroenteritis Intestinal Permeability Irritable Bowel Syndrome Patient Acute Gastroenteritis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Hungin APS, Chang L, Locke GR, et al.: Irritable bowel syndrome in the United States: prevalence, symptom patterns and impact. Aliment Pharmacol Ther 2005, 21:1365–1375.PubMedCrossRefGoogle Scholar
  2. 2.
    Rodriguez LA, Ruigomez A: Increased risk of irritable bowel syndrome after bacterial gastroenteritis: cohort study. Br Med J 1999, 318:565–566.Google Scholar
  3. 3.
    Spiller RC, Campbell E: Post-infectious irritable bowel syndrome. Curr Opin Gastroenterol 2006, 22:13–17.PubMedCrossRefGoogle Scholar
  4. 4.
    Spiller RC, Jenkins D, Thornley JP, et al.: Increased rectal mucosal enteroendocrine cells, T lymphocytes and increased gut permeability following acute Campylobacter enteritis and in post-dysenteric irritable bowel syndrome. Gut 2000, 47:804–811.PubMedCrossRefGoogle Scholar
  5. 5.
    Gwee KA, Collins SM, Read NW: Increased rectal mucosal expression of interleukin 1beta in recently acquired postinfectious irritable bowel syndrome. Gut 2003, 52:523–526.PubMedCrossRefGoogle Scholar
  6. 6.
    Wang LH, Fang XC, Pan GZ: Bacillary dysentery as a causative factor of irritable bowel syndrome and its pathogenesis. Gut 2004, 53:1096–1101.PubMedCrossRefGoogle Scholar
  7. 7.
    Marshall JK, Thabane M, Borgaonkar MR, James C: Postinfectious irritable bowel syndrome after a food-borne outbreak of acute gastroenteritis attributed to a viral pathogen. Clin Gastroenterol Hepatol 2007, 5:457–460.PubMedCrossRefGoogle Scholar
  8. 8.
    Longstreth GF, Thompson WG, Chey WD, et al.: Functional bowel disorders. Gastroenterology 2006, 130:1480–1491.PubMedCrossRefGoogle Scholar
  9. 9.
    Dunlop SP, Jenkins D, Spiller RC: Distinctive histological patterns of chronic inflammatory cells in rectal biopsies of patients with different clinical subtypes of IBS. Gastroenterology 2002, 122(Suppl 1):A60.Google Scholar
  10. 10.
    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, 123:307–322.Google Scholar
  11. 11.
    McKendrick MW, Read NW: Irritable bowel syndrome—post Salmonella infection. J Infect 1994, 29:1–3.PubMedCrossRefGoogle Scholar
  12. 12.
    Gwee KA, Graham JC, McKendrick MW, et al.: Psychometric scores and persistence of irritable bowel after infectious diarrhoea. Lancet 1996, 347:150–153.PubMedCrossRefGoogle Scholar
  13. 13.
    Neal KR, 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. Br Med J 1997, 314:779–782.Google Scholar
  14. 14.
    Locke GR, Yawn BP, Woolan PC, Lydick E: The incidence of clinically diagnosed irritable bowel syndrome in the community [abstract]. Gastroenterology 1999, 116:A76.Google Scholar
  15. 15.
    Wheeler JG, Sethi D, Cowden JM, et al.: Study of infectious intestinal disease in England: rates in the community, presenting to general practice, and reported to national surveillance. The Infectious Intestinal Disease Study Executive. Br Med J 1999, 318:1046–1050.Google Scholar
  16. 16.
    Parry SD, Stansfield R, Jelley D, et al.: Does bacterial gastroenteritis predispose people to functional gastrointestinal disorders? A prospective, community-based, case-control study. Am J Gastroenterol 2003, 98:1970–1975.PubMedGoogle Scholar
  17. 17.
    Halvorson HA, Schlett CD, Riddle MS: Post-infectious irritable bowel syndrome: a meta analysis. Am J Gastroenterol 2006, 101:1894–1899.PubMedCrossRefGoogle Scholar
  18. 18.
    Dunlop SP, Jenkins D, Neal KR, et al.: Relative importance of enterochromaffin cell hyperplasia, anxiety, and depression in postinfectious IBS. Gastroenterology 2003, 125:1651–1659.PubMedCrossRefGoogle Scholar
  19. 19.
    Gwee KA, Leong YL, Graham C, et al.: The role of psychological and biological factors in postinfective gut dysfunction. Gut 1999, 44:400–406.PubMedCrossRefGoogle Scholar
  20. 20.
    Dunlop SP, Jenkins D, Spiller RC: Distinctive clinical, psychological, and histological features of postinfective irritable bowel syndrome. Am J Gastroenterol 2003, 98:1578–1583.PubMedCrossRefGoogle Scholar
  21. 21.
    Spiller RC: Postinfectious irritable bowel syndrome. Gastroenterol 2003, 124:1662–1671.CrossRefGoogle Scholar
  22. 22.
    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, 17:1071–1075.PubMedCrossRefGoogle Scholar
  23. 23.
    Conner BA: Sequelae of traveler’s diarrhea: focus on postinfectious irritable bowel syndrome. Clin Infect Dis 2005, 41(Suppl 8):S577–S586.CrossRefGoogle Scholar
  24. 24.
    Borgaonkar MR, Ford DC, Marshall JK, et al.: The incidence of irritable bowel syndrome among community subjects with previous acute enteric infection. Dig Dis Sci 2006, 51:1026–1032.PubMedCrossRefGoogle Scholar
  25. 25.
    Okhuysen PC, Jiang ZD, Carlin L, et al.: Post-diarrhea chronic intestinal symptoms and irritable bowel syndrome in North American travelers to Mexico. Am J Gastroenterol 2004, 99:1774–1778.PubMedCrossRefGoogle Scholar
  26. 26.
    Mearin F, Perez-Oliveras M, Perello A, et al.: Dyspepsia and irritable bowel syndrome after a Salmonella gastroenteritis outbreak: one-year follow-up cohort study. Gastroenterology 2005, 129:98–104.PubMedCrossRefGoogle Scholar
  27. 27.
    Coates MD, Mahoney CR, Linden DR, et al.: Molecular defects in mucosal serotonin content and decreased serotonin reuptake transporter in ulcerative colitis and irritable bowel syndrome. Gastroenterology 2004, 126:1657–1664.PubMedCrossRefGoogle Scholar
  28. 28.
    Dunlop SP, Coleman NS, Blackshaw E, et al.: Abnormalities of 5-hydroxytryptamine metabolism in irritable bowel syndrome. Clin Gastroenterol Hepatol 2005, 3:349–357.PubMedCrossRefGoogle Scholar
  29. 29.
    Andrews C, Camilleri M, Bharucha AE, et al.: Serotonintransporter (SERT) polymorphism genotype and SERT expression in mucosal biopsies of patients with irritable bowel syndrome. Gastroenterology 2006, 125:A61.Google Scholar
  30. 30.
    Jones MA, Totemeyer S, Maskell DJ, et al.: Introduction of proinflammatory responses in the human monocytic cell line THP-1 by Campylobacter jejuni. Infect Immun 2003, 71:2626–2633.PubMedCrossRefGoogle Scholar
  31. 31.
    van der Veek PP, van den Berg M, de Kroon YE, et al.: Role of tumor necrosis factor-alpha and interleukin-10 gene polymorphisms in irritable bowel syndrome. Am J Gastroenterol 2005, 100:2510–2516.PubMedCrossRefGoogle Scholar
  32. 32.
    Gonsalkorale WM, Perrey C, Pravica V, et al.: Interleukin 10 genotypes in irritable bowel syndrome: evidence for an inflammatory component? Gut 2003, 52:91–93.PubMedCrossRefGoogle Scholar
  33. 33.
    Chadwick VS, Chen W, Shu D, et al.: Activation of the mucosal immune system in irritable bowel syndrome. Gastroenterology 2002, 122:1778–1783.PubMedCrossRefGoogle Scholar
  34. 34.
    Barbara G, Vallance BA, Collins SM: Persistent intestinal neuromuscular dysfunction after acute nematode infection in mice. Gastroenterology 1997, 113:1224–1232.PubMedCrossRefGoogle Scholar
  35. 35.
    Barbara G, Stanghellini V, De Giorgio R, et al.: Activated mast cells in proximity to colonic nerves correlate with abdominal pain in irritable bowel syndrome. Gastroenterology 2004, 126:693–702.PubMedCrossRefGoogle Scholar
  36. 36.
    Fu LW, Pan HL, Longhurst JC: Endogenous histamine stimulate ischemically sensitive abdominal visceral afferents through H1 receptors. Am J Physiol 1997, 273:H2726–H2737.PubMedGoogle Scholar
  37. 37.
    Dunlop SP, Hebden J, Campbell E, et al.: Abnormal intestinal permeability in subgroups of diarrhea-predominant irritable bowel syndrome. Am J Gastroenterol 2006, 101:1288–1294.PubMedCrossRefGoogle Scholar
  38. 38.
    Marshall JK, Thabane M, Garg AX, et al.: Intestinal permeability in patients with irritable bowel syndrome after a waterborne outbreak of acute gastroenteritis in Walkerton, Ontario. Aliment Pharmacol Ther 2004, 20:1317–1322.PubMedCrossRefGoogle Scholar
  39. 39.
    Vanner SJ, Depew WT, Paterson WG, et al.: Predictive value of the Rome criteria for diagnosing the irritable bowel syndrome. Am J Gastroenterol 1999, 94:2912–2917.PubMedCrossRefGoogle Scholar
  40. 40.
    Rodríguez L, Ruigómez A, Panés J: Acute gastroenteritis is followed by an increased risk of inflammatory bowel disease. Gastroenterology 2006, 130:1588–1594.CrossRefGoogle Scholar
  41. 41.
    Bohr J, Tysk C, Eriksson S, et al.: Collagenous colitis: a retrospective study of clinical presentation and treatment in 163 patients. Gut 1996, 39:846–851.PubMedCrossRefGoogle Scholar
  42. 42.
    Parry SD, Barton JR, Welfare MR: Is lactose intolerance implicated in the development of post-infectious irritable bowel syndrome or functional diarrhoea in previously asymptomatic people? Eur J Gastroenterol Hepatol 2002, 14:1225–1230.PubMedCrossRefGoogle Scholar
  43. 43.
    Page J, Dirnberger GM: Treatment of the irritable bowel syndrome with bentyl (dicyclomine hydrochloride). J Clin Gastroenterol 1981, 3:153–156.PubMedCrossRefGoogle Scholar
  44. 44.
    Clouse RE: Antidepressants for irritable bowel syndrome. Gut 2003, 52:598–599.PubMedCrossRefGoogle Scholar
  45. 45.
    De Ponti F, Tonini M: Irritable bowel syndrome: new agents targeting serotonin receptor subtypes. Drugs 2001, 61:317–332.PubMedCrossRefGoogle Scholar
  46. 46.
    Maxton DG, Morris J, Whorwell PJ: Selective 5-hydroxytryptamine antagonism: a role in irritable bowel syndrome and functional dyspepsia? Aliment Pharmacol Ther 1996, 10:595–599.PubMedCrossRefGoogle Scholar
  47. 47.
    Coffin B, Farmachidi JP, Rueegg P, et al.: Tegaserod a 5-HT4 receptor partial agonist, decreases sensitivity to rectal distention in healthy subjects. Aliment Pharmacol Ther 2003, 17:577–585.PubMedCrossRefGoogle Scholar
  48. 48.
    Floch MH: Use of diet and probiotic therapy in the irritable bowel syndrome: analysis of the literature. J Clin Gastroenterol. 2005, 39(Suppl):S243–S246.CrossRefPubMedGoogle Scholar
  49. 49.
    O’Mahony L, McCarthy J, Kelly P, et al.: Lactobacillus and bifidobacterium in irritable bowel syndrome: symptom responses and relationship to cytokine profiles. Gastroenterology 2005, 128:541–551.PubMedCrossRefGoogle Scholar
  50. 50.
    Dunlop SP, Jenkins D, Neal KR, et al.: Randomized, double-blind, placebo-controlled trial of prednisolone in post-infectious irritable bowel syndrome. Aliment Pharmacol Ther 2003, 18:77–84.PubMedCrossRefGoogle Scholar
  51. 51.
    Harvey RF, Mauad EC, Brown AM: Prognosis in the irritable bowel syndrome: a 5-year prospective study. Lancet 1987, 1:963–965.PubMedCrossRefGoogle Scholar
  52. 52.
    Neal KR, Barker L, Spiller RC: Prognosis in post-infective irritable bowel syndrome: a six year follow up study. Gut 2002, 51:410–413.PubMedCrossRefGoogle Scholar
  53. 53.
    McKendrick MW: Post Salmonella irritable bowel syndrome-5-year review. J Infect 1996, 33:170–171.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Division of GastroenterologyUniversity of Texas Medical BranchGalvestonUSA

Personalised recommendations