Estimating the importance of infection in IBS

Spiller, Robin C.

doi:10.1016/s0002-9270(02)05943-9

Cited by 4 publications

(5 citation statements)

References 18 publications

(29 reference statements)

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“…The results add to our earlier study which showed that Campylobacter gastroenteritis was a stronger predictor of IBS than glandular fever. 43 The current study suggests that this biological event may interact with a range of psychological variables in causing the onset of IBS. Gastroenteritis may trigger the symptoms, but cognitions, behaviour and emotions may help to prolong and maintain them over time.…”

Section: Discussionmentioning

confidence: 73%

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The cognitive behavioural model of irritable bowel syndrome: a prospective investigation of patients with gastroenteritis

Spence

Moss‐Morris

2007

Gut

142

108

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Aim: To determine whether a combination of mood and personality factors together with illness beliefs and behaviours predict the onset of irritable bowel syndrome (IBS) post gastroenteritis, as suggested by the cognitive behavioural model of IBS. Methods: Primary care patients with a positive test for Campylobacter gastroenteritis, and no previous history of IBS or serious bowel conditions were recruited into this prospective study (n = 620). Participants completed a questionnaire at the time of infection, which included standardised measures of mood, perceived stress, perfectionism, negative illness beliefs and illness behaviours. Participants completed follow-up questionnaires designed to determine whether they met the Rome criteria for IBS 3 and 6 months after initial infection. Results: A total of 49 participants met the criteria for IBS at both follow-up points. Logistic regressions indicated that those who developed IBS had significantly higher levels of perceived stress (1.10, 95% CI 1.02 to-1.15), anxiety (1.14, 95% CI 1.05 to 1.23), somatisation (1.17, 95% CI 1.02 to 1.35) and negative illness beliefs (1.14, 95% CI 1.03 to 1.27) at the time of infection than those who did not develop IBS. Patients with IBS were also significantly more likely to remain active in the face of their acute symptoms until they felt forced to rest (all-or-nothing behaviour) (1.09, 95% CI 1.03 to 1.16), and significantly less likely to initially rest in response to their acute illness (0.93, 95% CI 0.88 to 0.97). Depression and perfectionism were not associated with the onset of IBS. Conclusions: Results suggest that patients with high stress and anxiety levels are more prone to develop IBS after a bout of gastroenteritis. Additional risk factors include a tendency to interpret illness in a pessimistic fashion and to respond to symptoms in an all-or-nothing manner.

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Section: Discussionmentioning

confidence: 73%

“…Only a small minority of patients consult a doctor with gastroenteritis, so patients who get tested for the bacteria are not necessarily representative. 43 Future studies of outbreaks of gastroenteritis such as that conducted by Ji et al 44 represent a way around this problem, and are needed to replicate these results.…”

Section: Discussionmentioning

confidence: 98%

The cognitive behavioural model of irritable bowel syndrome: a prospective investigation of patients with gastroenteritis

Spence

Moss‐Morris

2007

Gut

142

108

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“…These findings should prompt, at the very least, a search for celiac disease in every new IBS patient, 43 and have also led to the suggestion that IBS might explain some instances of non‐responsive celiac disease 44 . The recent descriptions of increased intraepithelial lymphocytes in both the small intestine 45 and colon 46 in IBS raises the possibility of more direct relationships between these two disorders; Spiller, in an editorial on P‐I IBS and noting the role of interactions between genetic predisposition and infectious triggers in celiac disease, speculated that a parallel mechanism might be operative in this subgroup of IBS patients 47 …”

Section: The Role Of the External And Internal Environmentsmentioning

confidence: 99%

Irritable bowel syndrome and inflammatory bowel disease: interrelated diseases?

Quigley

2005

Chinese Journal of Digestive Diseases

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In the past inflammatory bowel disease (IBD), celiac disease and irritable bowel syndrome (IBS) were regarded as completely separate disorders. Now, with the description of inflammation, albeit low-grade, in IBS, and of symptom overlap between IBS and celiac disease, this contention has come under question. Is there true overlap between these disorders? Despite the limitations of available data one cannot but be struck by some areas of apparent convergence: IBD and celiac disease in remission, lymphocytic colitis and microscopic inflammation in IBS, in general, and, especially, in the post-infectious IBS category. The convergence between latent celiac disease and sub-clinical IBD, on the one hand, and IBS, on the other, appears, based on available evidence, to be somewhat spurious and may largely relate to misdiagnosis, a phenomenon which may also explain the apparent evolution of IBS into IBD in some studies. Similarities between IBS and lymphocytic colitis are more striking and less readily dismissed; as for IBS, well documented instances of progression of lymphocytic colitis to full-blown IBD are infrequent, suggesting a true separation between this disorder and classical IBD. Do IBS and lymphocytic colitis represent different responses to similar triggers? Will some of the 'inflamed' IBS subgroup be reclassified as part of the spectrum of lymphocytic colitis in the future? Will inflammation emerge as a common underlying factor in the pathogenesis of IBS? The answer to these and many questions must await further study of this fascinating area.

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“…IBS and GERD symptoms commonly cluster in families, 8, 12, 13 and while previous twin studies have also suggested that genetic factors are important, 6, 7, 9 a UK study has disputed there is any genetic component in IBS 14 . In addition, there is evidence that environmental factors, such as social learning early in life, 15, 16 psychological stress 17 and gastrointestinal (GI) infections, 18–20 are important in the development of IBS and dyspepsia. To date, the relative contribution of genetics to the development of dyspepsia has not been studied in twins.…”

Section: Introductionmentioning

confidence: 99%