Post-infectious IBS: Defining its clinical features and prognosis using an internet-based survey

Card T1,2, Enck P3, Barbara G4, Boeckxstaens GE5, Santos J6, Azpiroz F6, Mearin F7, Aziz Q8, Marshall J9, Spiller R1. United European Gastroenterol J. 2018 Oct;6(8):1245-1253. doi: 10.1177/2050640618779923. Epub 2018 May 23.

Author information

1 Nottingham Digestive Diseases Centre, University of Nottingham and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK.

2 Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.

3 Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany.

4 Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.

5 Translational Research Center for Gastrointestinal Disorders, University Hospital Leuven, Leuven, Belgium.

6 Digestive System Research Unit, University Hospital Vall d'Hebron, Bellaterra, Spain.

7 Institute of Functional and Motor Disorders, Centro Médico Teknon, Barcelona, Spain.

8 Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.

9 Department of Medicine, McMaster University, Ontario, Canada.


BACKGROUND: Gastrointestinal infection is an important risk factor for developing irritable bowel syndrome (IBS). Our aim was to characterise post-infectious IBS (PI-IBS) compared to other IBS patients.

METHODS: An internet survey of IBS patients using Rome III diagnostic questionnaire, Hospital Anxiety and Depression Scale (HADS) and Patient Health Questionnaire-12 Somatic Symptom (PHQ12-SS) scale score documenting the mode of onset was conducted.

RESULTS: A total of 7811 participants (63.2% female), of whom 1004 (13.3%) met criteria for PI-IBS, were studied. Seventy per cent of PI-IBS patients described sudden onset, 35% onset while travelling, 49.6% vomiting, 49.9% fever and 20.3% bloody diarrhoea. Compared to other IBS individuals, PI-IBS was significantly associated with living in Northern Europe and North America, having a hysterectomy, not having an appendicectomy, higher PHQ12-SS score and having more than one toilet in the family home. PI-IBS patients had more frequent stools. At one year recovery rate in the PI-IaBS and non-PI-IBS group was 19.7% and 22.2%, p = 0.15. Recovery rates were lower for females (20.7%) vs males (38.8%), those with somatisation (23.0%) vs those without (33.2%) and those living in North America or Northern Europe (21.1%) vs living elsewhere (33.9%) p ≤ 0.001.

CONCLUSION: PI-IBS accounts for around 13% of all IBS in this internet sample, with some distinctive features but a similar prognosis to the remainder.

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