Post-infectious Irritable Bowel Syndrome

Robin Spiller; Eugene Campbell

Disclosures

Curr Opin Gastroenterol. 2006;22(1):13-17. 

In This Article

Abstract and Introduction

Purpose of Review: Irritable bowel syndrome patients form a heterogeneous group with a variable contribution of central and peripheral components. The peripheral component is prominent in irritable bowel syndrome developing after infection (post-infectious irritable bowel syndrome) and this has proved a profitable area of research.
Recent Findings: Recent studies have overthrown the dogma that irritable bowel syndrome is characterized by no abnormality of structure by demonstrating low-grade lymphocytic infiltration in the gut mucosa, increased permeability and increases in other inflammatory components including enterochromaffin and mast cells. Furthermore, increased inflammatory cytokines in both mucosa and blood have been demonstrated in irritable bowel syndrome. While steroid treatment has proved ineffective, preliminary studies with probiotics exerting an anti-inflammatory effect have shown benefit.
Summary: The study of post-infectious irritable bowel syndrome has revealed the importance of low-grade inflammation in causing irritable bowel syndrome symptoms. It has suggested novel approaches to irritable bowel syndrome including studies of serotonin and histamine metabolism which may be relevant to other subtypes of of the disease.

Although the idea of irritable bowel syndrome (IBS) developing after infection is not new, being first clearly described in 1962,[1] scientific study of mechanisms is relatively recent. The demonstration of mucosal abnormalities, overthrowing years of dogma that IBS is characterized by no abnormality of structure, has stimulated others to re-examine the IBS gut. Post-infective IBS (PI-IBS) develops in 3-30% of individuals with bacterial gastroenteritis. Known risk factors include female sex, severity of initial illness, bacterial toxigenicity and adverse psychological factors, including neuroticism, hypochondriasis, anxiety and depression, as reviewed in 2003.[2] The purpose of the current review is to update the literature since 2003, during which time there has been an explosion of interest and many productive new approaches with implications for novel treatments.

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