Intestinal permeability in patients with irritable bowel syndrome after a waterborne outbreak of acute gastroenteritis in Walkerton, Ontario
Open accessAbstract
Summary: Background : Post‐infectious irritable bowel syndrome is a common clinical phenomenon of uncertain aetiology. Aim : To test the association between intestinal permeability and irritable bowel syndrome symptoms 2 years after a large waterborne outbreak of bacterial gastroenteritis. Methods : Consecutive adults with Rome I irritable bowel syndrome and controls without irritable bowel syndrome attending a community clinic were enrolled. Intestinal permeability was measured as the ratio of fractional urinary excretions of lactulose and mannitol, and compared among cases vs. controls and predictors of abnormal intestinal permeability were assessed. Results : A total of 218 subjects (132 irritable bowel syndrome cases and 86 non‐irritable bowel syndrome controls) completed the study protocol. About 27 (12%) had been diagnosed with the irritable bowel syndrome before the outbreak and 115 (53%) had been ill during the outbreak. Lactulose–mannitol ratios were increased among cases vs. controls (Mann–Whitney mean rank 118.8 vs. 95.3, P = 0.007), and cases were more likely to have a ratio >0.020 (P = 0.007). Among cases, those with increased intestinal permeability were more likely to report increased stool frequency. Both irritable bowel syndrome symptoms and male gender, but not diarrhoeal illness during the outbreak, were significant predictors of abnormal permeability. Conclusions : Irritable bowel syndrome symptoms are associated with a subtle increase in intestinal permeability irrespective of prior gastroenteritis. This may improve understanding of the aetiology of both sporadic and post‐infectious irritable bowel syndrome.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Other investigators have reported increased gastrointestinal permeability and elevated immune cell counts, even in patients with IBS without an infective aetiology.
“Other investigators have reported increased gastrointestinal permeability and elevated immune cell counts, even in patients with IBS without an infective aetiology. 54,55”
From Irritable bowel syndrome (2020) · cites this paper as [54]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
No citation lists for this paper
No citation lists for this paper yet — checked again daily.
References 24 · Cited by 292
Research works printed but not linked: 18
- Marshall JK, Thabane M, James C, Borgaonkar M, Collins SM. Incidence of post-infectious irritable bowel syndrome following a food-borne outbreak of acute gastroenteritis attributed to a viral pathogen. Am J Gastroenterol 2003; 98: S270 (abstract).
- Borgaonkar MR, Ford D, Marshall JK, Churchill E, Collins SM. The incidence of irritable bowel syndrome following infectious gastroenteritis. Am J Gastroenterol 2001; 96: 315.
- Gwee KA, Graham JC, McKendrick MW, et al. Psychometric scores and persistence of irritable bowel after infectious diarrhoea. Lancet 1996; 347: 150-3.
- Gwee K-A, Leong Y-L, Graham C, et al. The role of psychological and biological factors in post-infective gut dysfunction. Gut 1999; 44: 400-6.
- McKendrick MW, Read NW. Irritable bowel syndrome: post salmonella infection. J Infect 1994; 29: 1-3.
- 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. BMJ 1997; 314: 779-82.
- Stewart GT. Post-dysenteric colitis. BMJ 1950; 1: 405-9.
- Collins SM. A case for an immunological basis for irritable bowel syndrome. Gastroenterology 2002; 122: 2078-80.
- 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: 804-11.
- Talley NJ, Phillips SF, Melton J, Wiltgen C, Zinsmeister AR. A patient questionnaire to identify bowel disease. Ann Intern Med 1989; 111: 671-4.
- Meddings JB. Review article: Intestinal permeability in Crohn's disease. Aliment Pharmacol Ther 1997; 11: 47-56.
- Hilsden RJ, Meddings JB, Sutherland LR. Intestinal permeability changes in response to acetylsalicylic acid in relatives of patients with Crohn's disease. Gastroenterology 1996; 110: 1395-403.
- Gonsalkorale WM, Perrey C, Pravica V, Whorwell PJ, Hut- chinson IV. Interleukin 10 genotypes in irritable bowel syndrome: evidence for an inflammatory component? Gut 2003; 52: 91-3.
- Chadwick VS, Chen W, Shu D, et al. Activation of the mucosal immune system in irritable bowel syndrome. Gastroenterology 2002; 122: 1778-83.
- 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.
- Whorwell PJ, Holdstock G, Whorwell GM, Wright R. Bottle feeding, early gastroenteritis and inflammatory bowel disease. BMJ 1979; 1: 382.
- Rodriguez LA, Ruigomez A. Increased risk of irritable bowel syndrome after bacterial gastroenteritis: cohort study. BMJ 1999; 318: 565-6.
- Tagore A, Gonsalkorale WM, Pravica V, et al. Interleukin-10 genotypes in inflammatory bowel disease. Tissue Antigens 1999; 54: 386-90.
- Authors
- Marshall, J. K., Thabane, M., Garg, A. X., Clark, W., Meddings, J., Collins, S. M., & for the WEL Investigators
- Affiliations
- McMaster University (CA)
- Western University (CA)
- University of Calgary (CA)
- Corresponding author
- Marshall, J. K.
- Venue
- Alimentary Pharmacology & Therapeutics
- Publisher
- Wiley
- Published
- 2004-12
- Volume
- 20
- Issue
- 11-12
- Pages
- 1317-1322
- ISSN
- 0269-2813 (ISSN-L)
- 1365-2036
- OpenAlex
- W2012964005
- Cited by
- 292
- References
- 24
- Citations by year
- 2026: 3 · 2025: 9 · 2024: 6 · 2023: 8 · 2022: 6 · 2021: 15 · 2020: 11 · 2019: 15 · 2018: 14 · 2017: 9 · 2016: 9 · 2015: 12 · 2014: 19 · 2013: 25 · 2012: 20
- FWCI
- 8.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Alimentary Pharmacology & Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Ontario Ministry of Health and Long-Term Care
- Canadian Institutes of Health Research
- 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, intestinal permeability, post-infectious irritable bowel syndrome, waterborne outbreaks, bacterial gastroenteritis, lactulose/mannitol ratio, stool frequency, male sex, etiology
- MeSH terms
- Acute Disease, Adolescent, Adult, Aged, Aged, 80 and over, Bacterial Infections, Disease Outbreaks, Female, Gastroenteritis, Humans, Lactulose, Male, Mannitol, Middle Aged, Ontario, Permeability, Irritable Bowel Syndrome
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
