Persistent Abdominal Symptoms in US Adults After Short-Term Stay in Mexico

Authors

  • Parvathy Nair MD, PhD,

    1. Division of Epidemiology, Human Genetics and Environmental Sciences, Center for Infectious Disease, The University of Texas School of Public Health, Houston, TX, USA
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  • Pablo C. Okhuysen MD,

    1. Division of Epidemiology, Human Genetics and Environmental Sciences, Center for Infectious Disease, The University of Texas School of Public Health, Houston, TX, USA
    2. Division of Infectious Diseases, The University of Texas Medical School at Houston, Houston, TX, USA
    3. Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA
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  • Zhi-Dong Jiang MD, DrPH,

    1. Division of Epidemiology, Human Genetics and Environmental Sciences, Center for Infectious Disease, The University of Texas School of Public Health, Houston, TX, USA
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  • Lily G. Carlin BS,

    1. Division of Infectious Diseases, The University of Texas Medical School at Houston, Houston, TX, USA
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  • Jaime Belkind-Gerson MD,

    1. Division of Epidemiology, Human Genetics and Environmental Sciences, Center for Infectious Disease, The University of Texas School of Public Health, Houston, TX, USA
    2. Departmento de Enfermedades Cronicas, Instituto Nacional de Salud Publica, Cuernavaca, Mexico
    3. Division of Gastroenterology, Hepatology and Nutrition, Massachusetts General Hospital for Children, Boston, MA, USA
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  • Jose Flores MD,

    1. Division of Epidemiology, Human Genetics and Environmental Sciences, Center for Infectious Disease, The University of Texas School of Public Health, Houston, TX, USA
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  • Mercedes Paredes MD,

    1. Division of Epidemiology, Human Genetics and Environmental Sciences, Center for Infectious Disease, The University of Texas School of Public Health, Houston, TX, USA
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  • Herbert L. DuPont MD

    Corresponding author
    1. Division of Epidemiology, Human Genetics and Environmental Sciences, Center for Infectious Disease, The University of Texas School of Public Health, Houston, TX, USA
    2. Division of Infectious Diseases, The University of Texas Medical School at Houston, Houston, TX, USA
    3. Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA
    4. Internal Medicine Service, St. Luke's Medical Center, Houston, TX, USA
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Abstract

Background

Postinfectious irritable bowel syndrome (PI-IBS) has been reported as a complication of bacterial diarrhea including travelers' diarrhea (TD). This study assessed the role of TD among US students in Mexico in triggering the onset of persistent abdominal symptoms (PAS) and IBS.

Methods

We conducted a 6-month follow-up of a cohort of 817 US students in Mexico as short-term study to assess the frequency of PAS and IBS. Using Rome II criteria for IBS, groups of students with PAS were then categorized as PI-IBS if they met the symptom criteria for IBS or as suffering from functional abdominal disorder (FAD) if they did not meet the criteria.

Results

FAD and IBS were commonly found in US students 6 months after leaving Mexico. Important variables in their development were younger adult age, longer stays in Mexico and occurrence of acute diarrhea while in Mexico. Diarrhea while in Mexico occurred more commonly for those later diagnosed with FAD, 101/196 (52%), relative risk (RR) = 1.5 [confidence interval (CI) 1.2–1.8; p = 0.001]; IBS, 20/32 (63%), RR = 2.5 (CI 1.2–5.0; p = 0.007); and PAS (FAD + IBS), 121/228 (53%), RR = 1.5 (CI 1.2–1.8; p < 0.001) compared with subjects who had experienced diarrhea while in Mexico but were not diagnosed with PAS at 6 months, 227/589 (39%). Diarrhea caused by heat-labile enterotoxin-producing enterotoxigenic Escherichia coli or Providencia ssp. demonstrated a greater risk of developing PAS.

Conclusions

PAS occurred commonly in a subset of younger adult travelers who stayed longer in Mexico and experienced acute diarrhea while there. Further studies with this cohort will focus on host genetic associations with the development of PAS.

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