Cited by 359Gastrointestinal motility and disordersMicroscopic ColitisInflammatory Bowel Disease

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Distinctive Clinical, Psychological, and Histological Features of Postinfective Irritable Bowel Syndrome

Dunlop, Simon P, Jenkins, David, Spiller, Robin C·2003·American Journal of Gastroenterology

DOI 10.1111/j.1572-0241.2003.07542.x

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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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“jejuni enteritis have shown persistent low-grade rectal mucosal inflammation at least out to 4 years with increased numbers of T lymphocytes in the lamina propria as well as increased numbers of serotonin-containing enterochromaffin cells [55, 76, 85].”
Background
Persistent Travelers' Diarrhea
Connor, B. A. (2008) · Elsevier eBooks · doi:10.1016/b978-0-323-03453-1.10055-0 · Cited by 6
Plasma levels of guanylins are reduced in patients with Crohn’s disease
von Volkmann, H. L., Brønstad, I., Tronstad, R. R., Dizdar, V., Nylund, K., Hanevik, K., Hausken, T., Gilja, O. H., & Fiskerstrand, T. (2020) · Scandinavian Journal of Gastroenterology · doi:10.1080/00365521.2020.1748224 · Cited by 6
“according to specific Rome criteria [15].”
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Spiller, R. E. (2005) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2005.02.001 · Cited by 6
Self-citation
A Survey of Methodologies for Assessing Mast Cell Density and Activation in Patients with Functional Abdominal Pain Disorders
Friesen, H. J., Singh, M., Singh, V., Schurman, J. V., & Friesen, C. A. (2021) · Gastrointestinal Disorders · doi:10.3390/gidisord3040016 · Cited by 5
“[55] UK Mean 38–40 years IBS (75) Rectum Tryptase 4 Not stated Yes”
Background
Efficacy and mode of action of mesalazine in the treatment of diarrhoea-predominant irritable bowel syndrome (IBS-D): a multicentre, parallel-group, randomised placebo-controlled trial
Lam, C., Tan, W., Leighton, M., Hastings, M. C., Lingaya, M. R., Falcone, Y., Zhou, X., Xu, L., Whorwell, P. J., Walls, A. F., et al. (2015) · Efficacy and Mechanism Evaluation · doi:10.3310/eme02020 · Cited by 5
Self-citation
Long-Term Consequences of Cryptosporidium and Giardia Gastroenteritis
Hanevik, K. (2016) · Current Tropical Medicine Reports · doi:10.1007/s40475-016-0078-y · Cited by 6
“ogies except that it almost always has a diarrhea component either as diarrhea predominant or alternating between diarrhea and constipation [26, 27].”
Background
Functional Abdominal Pain in Children
Saps, M., & Dhroove, G. (2011) · Springer eBooks · doi:10.1007/978-1-4419-0350-1_8 · Cited by 5
Chronic Complications After Travelers' Diarrhea
DuPont, H. L. (2013) · Journal of Travel Medicine · doi:10.1111/jtm.12045 · Cited by 5
T1307 Treatment of Diarrhea-Predominant Irritable Bowel Syndrome with mesalazine and/or Saccharomyces Boulardii
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Decreased expression of serotonin in the jejunum and increased numbers of mast cells in the terminal ileum in patients with irritable bowel syndrome
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Randomized double‐blind placebo‐controlled study to evaluate the effect of long‐acting mesalamine on postinfectious irritable bowel syndrome with diarrhea
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Background
Parasitosis y síndrome de intestino irritable
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Irritable Bowel Syndrome Onset after New Coronavirus Infection COVID-19
Feklina, I. Y., Mnatsakanyan, M. G., Павлович, П. А., & Валерьевна, Т. О. (2022) · Russian Journal of Gastroenterology Hepatology Coloproctology · doi:10.22416/1382-4376-2021-31-6-23-28 · Cited by 4
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Role of antispasmodics in the treatment of irritable bowel syndrome
Drozdov, V., Arefev, K. I., Serebrova, S., Komissarenko, I., Shikh, E., & Starodubtsev, A. K. (2021) · Meditsinskiy sovet = Medical Council · doi:10.21518/2079-701x-2021-5-155-164 · Cited by 1
The evolution of irritable bowel syndrome as a group of organic diseases: a narrative review
Saidara, E., Barlow, G. M., & Pimentel, M. (2025) · Expert Review of Gastroenterology & Hepatology · doi:10.1080/17474124.2025.2549381 · Cited by 3
“Some studies have found mast cell hyperplasia to be more common in IBS-D, and others found it not to be related to PI-IBS [139–141].”
Sympathetic Overactivation Drives Colonic Eosinophil Infiltration Linked to Visceral Hypersensitivity in Irritable Bowel Syndrome
Duan, S., Kanda, H., Zhu, F., Okubo, M., Koike, T., Ohno, Y., Tanaka, T., Harima, Y., Miyamichi, K., Fukui, H., et al. (2025) · Cellular and Molecular Gastroenterology and Hepatology · doi:10.1016/j.jcmgh.2025.101658 · Cited by 4
Trastornos funcionales digestivos post-infecciosos: del episodio agudo a la molestia crónica
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Pathophysiological approach to chronic diarrhoea
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Irritable Bowel Syndrome
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DIARREA AGUDA
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Sadness and Anxiety Modify the Relationship Between COVID-19 and Gastrointestinal Symptoms at 6–12 Months of Follow-up
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“It is well-known that chronic GI symptoms can develop in response to infections of the digestive tract, a phenomenon known as postinfection IBS 7 – 10 and approximately 10% of patients meet criteria for IBS after a diagnosis of infectious enteritis.”
Background
Neuropathophysiology of the Irritable Bowel Syndrome
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Functional abdominal pain disorders and asthma: two disorders, but similar pathophysiology?
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Predictive Role of Personality Traits with Mediation of Affective Control in relationship with Irritable Bowel Syndrome (IBS) among the Students of Bushehr University of Medical Sciences (2013-2014)
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Etiology and pathophysiology of irritable bowel syndrome and chronic constipation
Camilleri, M. (2005) · Advanced studies in medicine · Cited by 3
Immune activation in irritable bowel syndrome: from basic to clinic
Bashashati, M. (2017) · NeuroGastroLATAM Reviews · doi:10.24875/ngl.m17000002 · Cited by 3
Chronic symptoms persisting after travel-related infections
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“PI-IBS is diagnosed according to the Rome IV criteria, with the additional criterion of onset following an acute infectious gastroenteritis characterised by two or more symptoms such as fever, vomiting, diarrhoea, and a positive stool culture result [14, 15].”
Method
Irritable Bowel Syndrome
Talley, N. J. (2010) · Elsevier eBooks · doi:10.1016/b978-1-4160-6189-2.00118-9 · Cited by 3
PATHOPHYSIOLOGICAL FACTORS OF IRRITABLE BOWEL SYNDROME, AND THE EFFECTS OF PROBIOTIC SUPPLEMENTATION
Kajander, K. (2008) · Työväentutkimus Vuosikirja · Cited by 3
Irritable Bowel Syndrome
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Psychiatric Disease and Functional GI Disorders in the Community: More Evidence for a Casual Link?
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Physical Activity and Irritable Bowel Syndrome: The Role of Evolutionary Mismatch in Chronic Disease Risk
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“Another, separate causal trajectory of IBS may be post-infectious in origin, resulting as a downstream health concern from bacterial gastrointestinal illnesses (Dunlop et al. 2003).”

Authors: Dunlop, S. P., Jenkins, D., & Spiller, R. C.
Affiliations: Nottingham University Hospitals NHS Trust (GB)
ORCID: Jenkins, David
Venue: American Journal of Gastroenterology
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2003-07
Volume: 98
Issue: 7
Pages: 1578-1583
ISSN: 0002-9270 (ISSN-L)
DOI: 10.1111/j.1572-0241.2003.07542.x
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 › Gastroenterology › Microscopic Colitis
Health Sciences › Medicine › Gastroenterology › 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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Distinctive Clinical, Psychological, and Histological Features of Postinfective Irritable Bowel Syndrome

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