Prevalence, Risk Factors, and Outcomes of Irritable Bowel Syndrome After Infectious Enteritis: A Systematic Review and Meta-analysis

doi:10.1053/j.gastro.2016.12.039

Gastroenterology

Volume 152, Issue 5, April 2017, Pages 1042-1054.e1

https://doi.org/10.1053/j.gastro.2016.12.039 Get rights and content

Background & Aims

Foodborne illness affects 15% of the US population each year, and is a risk factor for irritable bowel syndrome (IBS). We evaluated risk of, risk factors for, and outcomes of IBS after infectious enteritis.

Methods

We performed a systematic review of electronic databases from 1994 through August 31, 2015 to identify cohort studies of the prevalence of IBS 3 months or more after infectious enteritis. We used random-effects meta-analysis to calculate the summary point prevalence of IBS after infectious enteritis, as well as relative risk (compared with individuals without infectious enteritis) and host- and enteritis-related risk factors.

Results

We identified 45 studies, comprising 21,421 individuals with enteritis, followed for 3 months to 10 years for development of IBS. The pooled prevalence of IBS at 12 months after infectious enteritis was 10.1% (95% confidence interval [CI], 7.2−14.1) and at more than 12 months after infectious enteritis was 14.5% (95% CI, 7.7−25.5). Risk of IBS was 4.2-fold higher in patients who had infectious enteritis in the past 12 months than in those who had not (95% CI, 3.1−5.7); risk of IBS was 2.3-fold higher in individuals who had infectious enteritis more than 12 months ago than in individuals who had not (95% CI, 1.8−3.0). Of patients with enteritis caused by protozoa or parasites, 41.9% developed IBS, and of patients with enteritis caused by bacterial infection, 13.8% developed IBS. Risk of IBS was significantly increased in women (odds ratio [OR], 2.2; 95% CI, 1.6−3.1) and individuals with antibiotic exposure (OR, 1.7; 95% CI, 1.2−2.4), anxiety (OR, 2; 95% CI, 1.3−2.9), depression (OR, 1.5; 95% CI, 1.2−1.9), somatization (OR, 4.1; 95% CI, 2.7−6.0), neuroticism (OR, 3.3; 95% CI, 1.6−6.5), and clinical indicators of enteritis severity. There was a considerable level of heterogeneity among studies.

Conclusions

In a systematic review and meta-analysis, we found >10% of patients with infectious enteritis develop IBS later; risk of IBS was 4-fold higher than in individuals who did not have infectious enteritis, although there was heterogeneity among studies analyzed. Women—particularly those with severe enteritis—are at increased risk for developing IBS, as are individuals with psychological distress and users of antibiotics during the enteritis.

Section snippets

Methods

This systematic review was conducted and reported according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The process followed a priori established protocol (PROSPERO # CRD42016035317).

Results

From the previous systematic review, 16 studies were identified reporting prevalence of PI-IBS. With our updated systematic literature review, we identified an additional 29 unique articles meeting inclusion criteria. Therefore, we included 45 studies (N = 21,421 participants with IE exposure) that reported the prevalence of PI-IBS.4, 5, 7, 8, 9, 10, 11, 12, 13, 15, 16, 17, 20, 23, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57

Discussion

In this systematic analysis of 45 studies reporting on new-onset IBS in 21,421 subjects with IE, we made several key observations. First, we estimated a pooled point prevalence of PI-IBS of 11% (95% CI, 8.2−15.8), that is, about 1 in 9 (95% CI, 7−13) individuals develop new-onset IBS after an episode of IE. The most common phenotypes are IBS-M and IBS-D. The overall risk of developing IBS is 4.2 times higher in individuals exposed to IE, compared with nonexposed individuals, within the first

Acknowledgments

The authors wish to thank Ms Lori Anderson for administrative assistance and Mr Mark Curry for help with illustrations. The authors also acknowledge Dr Pensabene and Dr Nielsen for providing additional data on risk factors for PI-IBS development.

Dr Klem and Dr Wadhwa contributed equally to this work.

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: This article has an accompanying continuing medical education activity, also eligible for MOC credit, on page e14. Learning Objective: Upon completion of this CME activity, successful learners will be able to analyze summary estimates for risk and risk factors of Post Infection Irritable Bowel Syndrome (PI-IBS).

: Conflicts of interest The authors disclose no conflicts.

: Funding This study was funded by National Institutes of Health (NIH) K23 (DK103911), and American Gastroenterological Association Rome Foundation Functional Gastroenterology and Motility Disorders Pilot Research Award to Madhusudan Grover. NIH/National Library of Medicine training grant (T15LM011271) to Siddharth Singh.

: Author names in bold designate shared co-first authorship.

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Original ResearchFull Report: Clinical—Alimentary TractPrevalence, Risk Factors, and Outcomes of Irritable Bowel Syndrome After Infectious Enteritis: A Systematic Review and Meta-analysis

Background & Aims

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Acknowledgments

Gastroenterology

Clin Gastroenterol Hepatol

Clin Gastroenterol Hepatol

Gastroenterology

J Clin Epidemiol

J Clin Epidemiol

Control Clin Trials

Gastroenterology

Clin Gastroenterol Hepatol

Am J Gastroenterol

Gastroenterology

Am J Gastroenterol

J Infect

Lancet

Gastroenterology

Irritable bowel syndrome: a clinical review

JAMA

The irritable colon syndrome. A study of the clinical features, predisposing causes, and prognosis in 130 cases

Q J Med

Prevalence of gastrointestinal symptoms six months after bacterial gastroenteritis and risk factors for development of the irritable bowel syndrome: postal survey of patients

BMJ

The role of psychological and biological factors in postinfective gut dysfunction

Gut

Systematic review and meta-analysis: the incidence and prognosis of post-infectious irritable bowel syndrome

Aliment Pharmacol Ther

Postinfectious gastrointestinal disorders following norovirus outbreaks

Clin Infect Dis

Incidence of post-infectious irritable bowel syndrome and functional intestinal disorders following a water-borne viral gastroenteritis outbreak

Am J Gastroenterol

Rotavirus gastroenteritis: precursor of functional gastrointestinal disorders?

J Pediatr Gastroenterol Nutr

Development of functional gastrointestinal disorders after Giardia lamblia infection

BMC Gastroenterol

Irritable bowel syndrome and chronic fatigue 6 years after giardia infection: a controlled prospective cohort study

Clin Infect Dis

Irritable bowel syndrome and chronic fatigue 3 years after acute giardiasis: historic cohort study

Gut

Eight year prognosis of postinfectious irritable bowel syndrome following waterborne bacterial dysentery

Gut

Postinfectious irritable bowel syndrome: follow-up of a patient cohort of confirmed cases of bacterial infection with Salmonella or Campylobacter

Neurogastroenterol Motil

Increased risk of irritable bowel syndrome after bacterial gastroenteritis: cohort study

BMJ

Systematic review with meta-analysis: post-infectious irritable bowel syndrome after travellers’ diarrhoea

Aliment Pharmacol Ther

Development and validation of a risk score for post-infectious irritable bowel syndrome

Am J Gastroenterol

Irritable bowel syndrome among a cohort of European travelers to resource-limited destinations

J Travel Med

Measuring inconsistency in meta-analyses

BMJ

Original Research
Full Report: Clinical—Alimentary Tract
Prevalence, Risk Factors, and Outcomes of Irritable Bowel Syndrome After Infectious Enteritis: A Systematic Review and Meta-analysis