Long-Term Gastrointestinal Consequences are Frequent Following Sporadic Acute Infectious Diarrhea in a tropical country: A Prospective cohort Study

Abstract

FGIDs are common after AG; dyspeptic symptoms, CBD, and weight loss were risk factors for PI-FGIDs. Vibrio cholerae infection caused PI-FGID, which was never reported. About 9 % patients fulfilling the criteria for PI-IBS had PI-MAS.

Post-infection irritable bowel syndrome in the tropical and subtropical regions: Vibrio cholerae is a new cause of this well-known condition

“…Though subsequent infection in later life induces intestinal immune response quickly and effectively resulting in its clearance, the immune activation is switched off rapidly due to a strong Tregulatory function [69]. However, the two current studies from Bangladesh and India on PI-IBS suggest that the frequency of IBS after acute gastroenteritis was 16.5% and 26%, respectively [27,28]. These frequencies are somewhat comparable or higher than those reported in the other studies from the temperate countries (Table 1).…”

“…In this study, the authors found that about 9% of the patients fulfilling the Rome III criteria of PI-IBS had at least two abnormal mucosal absorption tests, (i) D-xylose hydrogen breath test, (ii) fecal fat microscopy using Sudan III stain, and (iii) histopathological examination of duodenal biopsies obtained endoscopically, suggesting these patients had PI-MAS or tropical sprue. In this study, 22% of the 23 subjects who were investigated for malabsorption had at least one test abnormal [27]. This study suggests that the patients who develop continued bowel symptoms after acute gastroenteritis need to be investigated for mucosal malabsorption even though they might have fulfilled the Rome criteria for IBS; this highlights the importance of further study on this issue on larger number of patients.…”

“…However, a number of studies reported the occurrence of PI-IBS after acute gastroenteritis caused by invasive bacteria. Some of the recent studies demonstrated that PI-IBS occurred after cholera and its frequency was comparable to other invasive bacteria [27,28]. Although the gut microbiota alteration has been studied in PI-IBS after acute gastroenteritis caused by invasive bacteria [62,63], currently, such alteration is unknown among PI-IBS patients resulting from cholera.…”

Marshall and Warren Lecture 2019: A paradigm shift in pathophysiological basis of irritable bowel syndrome and its implication on treatment

“…Further evidence of organic basis of PI‐IBS comes from the suggestion that postinfection bowel dysfunction is a spectrum disorder in which the milder end of the spectrum is PI‐IBS, and more severe end is postinfection malabsorption syndrome, popularly known as tropical sprue 52 . In fact, in a recent study, 9% of patients fulfilling Rome criteria for PI‐IBS have been found to have tropical sprue on further investigation 53 . The link between acute gastroenteritis, PI‐IBS, and tropical sprue is one of the best evidences for organic basis of a subset of patients with IBS 52 …”

Post-infection irritable bowel syndrome or tropical sprue: A paradigm shift

“…In a recent study from Bangladesh, of 345 subjects each with acute gastroenteritis and healthy controls, patients more often developed PI-IBS than controls (16.5% vs. 2.6%; p = 0.00). PI-MAS, diagnosed by abnormal results in at least two of the three tests, was present in 2/23 (9%) patients with PI-IBS 19 . Since all the patients developing PI-IBS were not tested for MAS, it is possible that the frequency of TS might have been underestimated in this study.…”