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Cited by 474Gastrointestinal motility and disordersGut microbiota and healthMicroscopic Colitis

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

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Klem, Fabiane, Wadhwa, Akhilesh, Prokop, Larry J., Sundt, Wendy J., Farrugia, Gianrico, Camilleri, Michael, Singh, Siddharth, Grover, Madhusudan·2017·Gastroenterology
DOI 10.1053/j.gastro.2016.12.039PMC PMC5367939
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Abstract

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.

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  • Risk factors for development of PI-IBS include female sex, antibiotic exposure, psychological distress preceding the illness, and severity of infection.

    “Risk factors for development of PI-IBS included female sex, antibiotic exposure, psychological distress preceding the illness, and severity of infection. 18”

    From Irritable bowel syndrome (2020) · cites this paper as [18]

    The Discussion identifies female sex, antibiotic treatment, psychological distress at the time of infectious enteritis, and clinical severity as risk factors. The claim changes the timing of psychological distress to before the illness; the Results mention prior stress only as a finding from an isolated study, not as the general finding summarized in the Discussion. (LLM, conf=0.86)

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  • Strong evidence supports a role for bacterial, viral or parasitic infections triggering IBS.

    “Strong evidence supports a role for bacterial, viral or parasitic infections triggering IBS.51”

    From British Society of Gastroenterology guidelines on the management of irritable bowel syndrome (2021) · cites this paper as [51]

  • Post-infection IBS can occur after bacterial, viral, or protozoal infection.

    “This is termed post-infection IBS (PI-IBS), and can occur after bacterial, viral, or protozoal infection. 18”

    From Irritable bowel syndrome (2020) · cites this paper as [18]

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Authors
Klem, F., Wadhwa, A., Prokop, L. J., Sundt, W. J., Farrugia, G., Camilleri, M., Singh, S., & Grover, M.
Affiliations
  • Mayo Clinic (US)
  • University of California San Diego (US)
Corresponding author
Grover, Madhusudan
ORCID
Venue
Gastroenterology
Publisher
Elsevier BV
Published
2017-04
Volume
152
Issue
5
Pages
1042-1054.e1
ISSN
0016-5085 (ISSN-L)
DOI
10.1053/j.gastro.2016.12.039
PMC
PMC5367939
OpenAlex
W2571057940
Cited by
474
References
70
Citations by year
2026: 43 · 2025: 44 · 2024: 62 · 2023: 53 · 2022: 64 · 2021: 68 · 2020: 54 · 2019: 35 · 2018: 46 · 2017: 5
FWCI
6.44
Type
journal article
Language
en
Open access
Licence
Locations
  • Gastroenterology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (DK103911, T15LM011271)
  • U.S. National Library of Medicine (DK103911, T15LM011271)
Topics
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
  • Health Sciences › Medicine › Epidemiology › Microscopic Colitis
Keywords
irritable bowel syndrome, infectious enteritis, food poisoning, post-infectious IBS, IBS prevalence, risk factors, protozoan infection, bacterial infection, antibiotic exposure, anxiety, depression, somatization, sex differences
MeSH terms
Neuroticism, Anti-Bacterial Agents, Anxiety, Anxiety Disorders, Bacterial Infections, Depression, Enteritis, Female, Foodborne Diseases, Humans, Intestinal Diseases, Parasitic, Male, Risk Factors, Severity of Illness Index, Sex Factors, Somatoform Disorders, Prevalence, Odds Ratio, Irritable Bowel Syndrome

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