Post-infectious irritable bowel syndrome: The past, the present and the future

Authors

  • Uday C Ghoshal,

    Corresponding author
      Uday C Ghoshal, Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India. Email: udayghoshal@gmail.com
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  • Prabhat Ranjan

    1. Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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  • Conflict of interest

  • No potential conflict of interest to disclose.

Uday C Ghoshal, Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India. Email: udayghoshal@gmail.com

Abstract

Background:  Irritable bowel syndrome (IBS), once thought to be a psychosomatic disease, is being considered to be more organic. Post-infectious IBS (PI-IBS), defined as acute onset IBS (by Rome criteria) after gastrointestinal infection in an individual without prior IBS with two or more of the followings: fever, vomiting, diarrhea, a positive stool culture. The recent and old literature of PI-IBS will be reviewed. Future directions for research will be presented.

Methods:  Literature on PI-IBS was reviewed by electronic search and cross references of these papers.

Results:  Interest in studies on PI-IBS, which was described five to six decades ago, re-surfaced recently. 3.6 to 32% patients with acute gastroenteritis develop PI-IBS during 3–12 month follow-up. PI-IBS is commonly diarrhea predominant. Factors implicated in development include nature of pathogens, duration and severity of diarrhea, younger age, female gender and psychological co-morbidities like anxiety and depression. The pathogenesis of PI-IBS is largely related to continuing gut inflammation due to inability of the host to contain the inflammatory reaction, altered gut microbiota, increased intestinal permeability, muscle hyper-contractility and visceral hypersensitivity. There could be an overlap between PI-IBS and post-infectious malabsorption syndrome (PI-MAS), popularly known as tropical sprue.

Conclusions:  Development of IBS in a subset of patients with acute gastroenteritis is uncontested. This is expected to open a paradigm shift in understanding the pathogenesis of IBS. Future studies should address the issue of overlap of PI-IBS and PI-MAS. Exploring the molecular mechanisms of pathogenesis of PI-IBS may help to design preventive and therapeutic strategies.

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