Study Links Travelers' Diarrhea to Chronic GI Complaints

Peggy Peck

October 13, 2003

Oct. 13, 2003 (San Diego) — Travelers' diarrhea, which is often regarded as little more than a nuisance for vacationers, may trigger chronic complaints, including irritable bowel syndrome (IBS), according to the results of a study presented here at the 41st annual meeting of the Infectious Diseases Society of America.

Pablo Okhuysen, MD, lead researcher and associate professor of medicine at the University of Texas Health Sciences Center in Houston, and colleagues prospectively followed 146 students who traveled to Mexico. "Having diarrhea while they were in Mexico and having more than one episode while traveling correlated with the likelihood of developing IBS," he said. "This confirms that there is probably a relationship between infectious gastroenteritis and IBS."

Many IBS patients report onset of chronic symptoms after an initial attack of gastroenteritis, Dr. Okhuysen said. Published studies suggest that 7% to 33% of patients with bacterial gastroenteritis develop postinfection IBS (PI-IBS). Thus, he hypothesized that travelers' diarrhea could also trigger IBS.

Dr. Okhuysen and colleagues recruited 146 students who were followed prospectively for four weeks after arrival in Mexico. Students who developed diarrhea were assessed for the presence of enteric pathogens. Assessment of chronic gastrointestinal symptoms was done by questionnaire, which was mailed to the students six months after their return to the U.S. Symptoms were evaluated according to the Rome II criteria to determine the presence of PI-IBS.

Sixty-two students developed diarrhea while traveling in Mexico and a total of 98 students completed the six-month follow-up, Dr. Okhuysen said.

Before travel, only one student met the criteria for IBS, but after travel seven students met IBS criteria, he said. Additionally, at the six-month follow-up, 17 students reported chronic abdominal pain compared with five students before the trip; 17 students also reported chronic diarrhea, defined as diarrhea lasting two weeks or longer, while just one student reported chronic diarrhea before traveling to Mexico, he said.

All students who reported posttravel IBS experienced diarrhea while in Mexico, while none of the students who were asymptomatic while in Mexico met the definition of IBS six months after travel. The researchers found that the risk of posttravel IBS or posttravel gastrointestinal symptoms correlated with the severity of traveler's diarrhea while in Mexico. Typically, students who reported chronic gastrointestinal complaints experienced at least two episodes of diarrhea while traveling, Dr. Okhuysen said.

In an interview, Douglas Mitchell, MD, associate professor of pediatric medicine at the Eastern Virginia Medical School in Norfolk, called the study "an eye-opener." Dr. Mitchell, who was not involved in the study, said it is "a good first study looking at adults who travel into developing areas, clearly showing the risk of moving from having travelers' diarrhea, which is very common, to developing symptoms consistent with chronic diarrhea or IBS."

The goal should be to prevent travelers' diarrhea, Dr. Okhuysen said, but failing that the study should serve as a wake-up call about the need to "follow patients who develop symptoms while traveling."

IDSA 41st Annual Meeting: Poster 876. Presented October 11, 2003.

Reviewed by Gary D. Vogin, MD

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