Distinctive Clinical, Psychological, and Histological Features of Postinfective Irritable Bowel Syndrome
Abstract
OBJECTIVE: Irritable bowel syndrome after gastroenteritis is well recognized. Our aim was to determine whether postinfective IBS (PI-IBS) has histological or clinical features that are distinct from those of IBS patients with no history of preceding infection. METHODS: A total of 75 consecutive IBS outpatients and 36 healthy control subjects completed a questionnaire detailing symptoms, mode of onset, and previous psychiatric history. All underwent a full diagnostic workup including rectal biopsy, which included immunostaining and quantification for lamina propria or intraepithelial T lymphocytes, serotonin-containing enterochromaffin (EC), and mast cells. Patients were divided according to onset of symptoms into PI-IBS (n = 23) or non-PI-IBS (n = 52) patients. RESULTS: Diarrhea predominance occurred more frequently in PI-IBS (70%) than in non-PI-IBS (42%) patients (p = 0.03). A history of previous treatment for anxiety or depression was present in 26% of PI-IBS patients compared to 54% of non-PI-IBS (p = 0.02). Biopsy results for all patients were normal using conventional criteria; however, quantification revealed that PI-IBS showed increased EC cells compared to those of non-PI-IBS patients (p = 0.017) and controls (p = 0.02). Lamina propria T lymphocytes were increased in PI-IBS (p = 0.026) and non-PI-IBS (p = 0.011) patients compared to controls. Mast cells were increased in non-PI-IBS patients (p = 0.054) compared to controls. CONCLUSIONS: Individuals with PI-IBS are a clinically distinct subgroup characterized by diarrheal symptoms, less psychiatric illness, and increased serotonin-containing EC cells compared to those with non-PI-IBS.
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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 [55]
Increased concentrations of CD3+ T cells in the colon and rectum and in the myenteric plexus of the small intestine were increased in patients with IBS or PI-IBS compared with normal controls.
“Additionally, increased concentrations of CD3+ T cells in the colon and rectum and in the myenteric plexus of the small intestine were increased in these patients compared with normal controls (36, 46, 57, 58, 89, 94, 133, 168, 174).”
From Intestinal microbiota and immune function in the pathogenesis of irritable bowel syndrome (2013) · cites this paper as [58]
Intestinal epithelial lymphocytes are not consistently elevated in IBS patients.
“However, as with mast cells, IELs are not consistently elevated in IBS patients (57, 58, 133).”
From Intestinal microbiota and immune function in the pathogenesis of irritable bowel syndrome (2013) · cites this paper as [58]
Some studies failed to demonstrate increased activated mast cells in IBS patients.
“However, some studies failed to demonstrate increased activated mast cells in IBS patients (35, 36, 57, 58, 168) and there are no consistent differences in the tissue concentrations of activated mast cells in patients with different IBS subtypes (36, 189).”
From Intestinal microbiota and immune function in the pathogenesis of irritable bowel syndrome (2013) · cites this paper as [58]
In patients with PI-IBS, activation of the GI immune system follows acute GI infection.
“The importance of the interaction between the intestinal microbiota and immune system in IBS patients is demonstrated by a few studies in patients with PI-IBS, indicating activation of the GI immune system following the acute GI infection (57, 58, 75, 89, 94, 124, 168, 170, 187)”
From Intestinal microbiota and immune function in the pathogenesis of irritable bowel syndrome (2013) · cites this paper as [58]
Evidence from in vitro studies on norepinephrine may shed light on the reported association of stressful life events with the duration of gastroenteritis and with the subsequent development of postinfectious IBS.
“The evidence from these in vitro studies may shed light on the reported association of stressful life events with the duration of gastroenteritis, and with the subsequent development of postinfectious IBS.37”
From Principles and clinical implications of the brain-gut-enteric microbiota axis (2009) · cites this paper as [37]
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- Authors
- Dunlop, S. P., Jenkins, D., & Spiller, R. C.
- Affiliations
- Nottingham University Hospitals NHS Trust (GB)
- ORCID
- Jenkins, David
- Venue
- American Journal of Gastroenterology
- Published
- 2003-07
- Volume
- 98
- Issue
- 7
- Pages
- 1578-1583
- ISSN
- 0002-9270 (ISSN-L)
- OpenAlex
- W2033889517
- Cited by
- 359
- References
- 32
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 4 · 2023: 6 · 2022: 6 · 2021: 5 · 2020: 10 · 2019: 9 · 2018: 14 · 2017: 13 · 2016: 17 · 2015: 14 · 2014: 28 · 2013: 24 · 2012: 23
- FWCI
- 12.90
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Epidemiology › Microscopic Colitis
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
- Keywords
- irritable bowel syndrome, gastroenteritis, rectal biopsy, enterochromaffin cells, serotonin, mast cells, diarrhea, psychiatric comorbidity, anxiety, depression, immunohistochemistry
- MeSH terms
- Adult, Mental Disorders, Biopsy, Cell Count, Colonic Diseases, Functional, Diarrhea, Enterochromaffin Cells, Female, Gastroenteritis, Humans, Immunohistochemistry, Male, Mast Cells, Middle Aged, Rectum, Serotonin, T-Lymphocytes
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