Acute gastroenteritis linked to increased odds for postinfection IBS, functional dyspepsia
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Key takeaways:
- The prevalence of postinfection IBS and functional dyspepsia was 14.5% and 12.7%, respectively, after acute gastroenteritis.
- IBS persisted in 52.3% of patients at 1 to 4 years follow-up and in 39.5% at 5 years.
Patients with acute gastroenteritis had up to fourfold increased odds for developing postinfection irritable bowel syndrome or functional dyspepsia, with a higher risk associated with proinflammatory microbes and SARS-CoV-2, data showed.
“Consolidated evidence shows that acute infectious gastroenteritis represents a common risk factor for the development of disorders of gut-brain interaction (DGBI),” Serena Porcari, MD, of the department of translational medicine and surgery at Catholic University of the Sacred Heart in Rome, and colleagues wrote in Gut. “Specific subgroups of DGBI have a clear postinfection (PI) origin, including PI-IBS, defined as the development of IBS after an episode of acute gastroenteritis, and PI-FD, defined as onset of a symptom complex characterized by epigastric pain, bloating, early satiety, fullness, epigastric burning, belching, nausea and vomiting, following an acute gastroenteritis.”
They continued: “Despite the available data, it is still difficult to provide a clear and contemporaneous picture of the epidemiology of PI-IBS and PI-FD for several reasons.”
In a systematic review and meta-analysis, researchers analyzed data from 47 observational studies, which included 28,170 individuals, to determine the prevalence of PI-IBS and PI-FD following acute gastroenteritis. Eligible studies included at least 50 adults and reported the proportion of patients with IBS or FD within at least 3 months of an episode of acute gastroenteritis.
According to results, of 46 studies that reported prevalence of PI-IBD, the pooled prevalence was 14.5% (95% CI, 11.2-18.1), and of 13 studies reporting PI-FD, the prevalence was 12.7% (95% CI, 6.6-20.4). Upon pooling data from case-control studies, researchers reported that patients with a history of acute gastroenteritis had fourfold and threefold increased odds for IBS and FD, respectively.
Although the pooled persistence of FD “could not be assessed with available data,” researchers reported that IBS persisted in 52.3% of individuals at a follow-up of 1 to 4 years and in 39.8% (95% CI, 33.5-46.2) at more than 5 years.
Results of a subgroup analysis showed that PI-IBS was “most commonly associated” with parasitic infections (30.1%; 95% CI, 4.5-66.1) in two studies, followed by bacterial infections (18.3%; 95% CI, 14.3-22.6) in 20 studies and viral infections (10.7%; 95% CI, 6.3-16) in 13 studies. Campylobacter infection was associated with the highest PI-IBS prevalence (20.7%; 95% CI, 13.7-28.6), while Proteobacteria (OR = 5.4; 95% CI, 2.5-11.9) and SARS-CoV-2 infections (OR = 5.4; 95% CI, 1.2-24.7) had the highest odds for PI-IBS.
According to researchers, PI-FD was associated with bacterial infections (13.6%; 95% CI, 4.8-26) in four studies and SARS-CoV-2 infection (10%; 95% CI, 2.3-23.6) in five studies. The prevalence of FD was even higher following Enterobacteriaceae infections (19.4%; 95% CI, 5.9-38.3).
“Our findings provide an update to the epidemiology of PI-IBS and PI-FD and of the likelihood of developing them after acute gastroenteritis, together with an unprecedented evaluation of IBS persistence over time after initial diagnosis that suggests a stable chronicization of the disease in affected individuals,” Porcari and colleagues wrote. “Moreover, our data suggest that infections from proinflammatory taxa, that is, Proteobacteria, and SARS-CoV-2, may be associated with PI-IBS and PI-FD.”
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