Post-Traveler's Diarrhea Irritable Bowel Syndrome: A Prospective Study

Ilnyckyj, Alexandra; Balachandra, Brinda; Elliott, Lawrence; Choudhri, Shurjeel

doi:10.1111/j.1572-0241.2003.07297.x

Cited by 87 publications

(37 citation statements)

References 9 publications

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“…Although Ͻ1% of affected travelers require hospitalization, 80 some studies have shown that 4%-11% of affected travelers develop postinfectious irritable bowel syndrome (PI-IBS). 81,82 Traveler's diarrhea is associated with travel from lowrisk to high-risk regions; risk areas are stratified as low risk (4% risk of developing diarrhea), intermediate risk (15% risk of developing diarrhea), and high risk (40% risk of developing diarrhea). 83 According to the US Centers for Disease Control and Prevention, high-risk regions include Africa (excluding South Africa), South and Central America (excluding Chile and Argentina), as well as most of the Middle East, Southern and Southeast Asia, and Oceania.…”

Section: Traveler's Diarrheamentioning

confidence: 99%

Diagnosis and Treatment of Acute or Persistent Diarrhea

2009

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Studies of microbial pathogens and the toxins they produce are important for determining the mechanisms by which they cause disease and spread throughout a population. Some bacteria produce secretory enterotoxins (such as choleratoxin or the heat-labile or stable enterotoxins produced by E. coli) that invade cells directly. Others produce cytotoxins (such as those produced by Shigella, enteroinvasive E. coli, or C. difficile) that damage cells or trigger host responses that cause small or large bowel diseases (such as enteroaggregative or enteropathogenic E. coli or Salmonella). Viruses (such as noroviruses and rotaviruses) and protozoa (such as Cryptosporidium, Giardia or Entameba histolytica) disrupt cell functions and cause short-or long-term disease. Much epidemiological data about these pathogens have been collected from community-and hospital-acquired settings, as well from patients with traveler's or persistent diarrhea. These studies have led to practical approaches for prevention, diagnosis and treatment.

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Section: Traveler's Diarrheamentioning

confidence: 99%

Diagnosis and Treatment of Acute or Persistent Diarrhea

2009

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“…Chronic diarrhea places a strain on healthcare resources as up to half of travelers returning from tropical and sub-tropical destinations develop infectious diarrhea [1–4, 6], and an estimated 10 % of those will go on to develop PI-IBS [30]. Despite the prevalence of PI-IBS, this systematic review found only 8 pharmacological and 1 non-pharmacological intervention trials specific to the management of PI-IBS.…”

Section: Discussionmentioning

confidence: 99%

“…Traveler’s diarrhea (TD) is a frequent cause of illness in returning travelers, and it is most often attributable to bacterial causes [1–3]. It has been well documented that acute gastroenteritis and dysentery due to TD are associated with increased risk of developing post-infectious irritable bowel syndrome (PI-IBS) in both adults and children [4, 5].…”

Section: Introductionmentioning

confidence: 99%

Interventions for post-infectious irritable bowel syndrome: a systematic review of treatment efficacy

Torbicki

Mishra

et al. 2015

Trop Dis Travel Med Vaccines

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BackgroundPost-infectious irritable bowel syndrome (PI-IBS) due to traveler’s diarrhea is the second most common illness seen in post-travel clinics, yet its optimal management remains unknown. We performed a systematic review to evaluate treatment efficacy in PI-IBS.MethodsWe searched Medline, EMBASE, LILACS, CINAHL, CAB abstracts, and the Cochrane Library to February 3, 2014 for intervention studies of the pharmacologic and non-pharmacologic management of PI-IBS and examined the evidence according to a modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) scale.ResultsOf 336 records, 9 studies were included. Eight studies of pharmacologic interventions examined 5 agents (mesalazine or mesalamine, ondansetron, prednisolone, cholestyramine, and metronidazole). One study examined the non-pharmacologic intervention of different infant nutritional formulas following acute gastroenteritis. The quality of the evidence to date was low, with small sample size (fewer than 50 participants) and short duration of follow-up. Overall, the efficacy of pharmacological treatment ranged from no benefit (ondansetron and prednisolone) to moderately beneficial (cholestyramine and metronidazole). The evidence for mesalazine was equivocal: one study showed benefit, two others showed none.ConclusionsHeterogeneity in outcome measures and low strength of evidence preclude recommendations on the optimal management of PI-IBS by a specific agent. More comparative intervention research into PI-IBS treatment is needed for consistent best practice in PI-IBS management. Clinicians may elect to pursue therapeutic trials of mesalazine, cholestyramine, or metronidazole in individual patients, but should be aware that data supporting the efficacy of these agents is limited.Electronic supplementary materialThe online version of this article (doi:10.1186/s40794-015-0002-9) contains supplementary material, which is available to authorized users.

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“…A subsequent retrospective study by Chaudhary and Truelove found that a substantial proportion of patients with IBS reported the onset of their symptoms after an acute episode of GE [20] . Since then, various prospective and retrospective studies from the United Kingdom, North America, Spain, Korea, Israel and New Zealand have reported the incidence or prevalence of PI-IBS to range from 5% to 32% [4][5][6][7][8][9][10][11][12][13][21][22][23][24][25] . Consistent among these studies is the suggestion that PI-IBS is a global phenomenon, and not unique to any ethnic group or environment.…”

Section: Epidemiologymentioning

confidence: 99%

“…In some patients, IBS symptoms arise de novo following an exposure to acute gastroenteritis (GE). This phenomenon, known as post-infectious IBS (PI-IBS), denotes the persistence of abdominal discomfort, bloating and diarrhea that continue despite clearance of the inciting pathogen [3][4][5][6][7][8][9][10][11][12][13][14][15] . A recent systematic review and meta-analysis demonstrated that the risk of developing IBS increases six-fold after gastrointestinal infection [16] and remains elevated for at least 2-3 years postinfection.…”

Section: Introductionmentioning

confidence: 99%

Post-infectious irritable bowel syndrome

Thabane¹,

Marshall²

2009

WJG

147

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Post-infectious irritable bowel syndrome (PI-IBS) is a common disorder wherein symptoms of IBS begin after an episode of acute gastroenteritis. Published studies have reported incidence of PI-IBS to range between 5% and 32%. The mechanisms underlying the development of PI-IBS are not fully understood, but are believed to include persistent sub-clinical inflammation, changes in intestinal permeability and alteration of gut flora. Individual studies have suggested that risk factors for PI-IBS include patients' demographics, psychological disorders and the severity of enteric illness. However, PI-IBS remains a diagnosis of exclusion with no specific disease markers and, to date, no definitive therapy exists. The prognosis of PI-IBS appears favorable with spontaneous and gradual resolution of symptoms in most patients.

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Post-Traveler's Diarrhea Irritable Bowel Syndrome: A Prospective Study

Abstract: This study does not support a large association between TD and an increased risk of developing IBS. A small increase in relative risk may have been undetected because of the size of the study.

Cited by 87 publications

References 9 publications

Diagnosis and Treatment of Acute or Persistent Diarrhea

Diagnosis and Treatment of Acute or Persistent Diarrhea

Interventions for post-infectious irritable bowel syndrome: a systematic review of treatment efficacy

Post-infectious irritable bowel syndrome

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