Post-infectious irritable bowel syndrome


Emilija Šabatina1, Mindaugas Stonis1, Tomas Tvarijonas1

1 Lithuanian University of Health Sciences, Academy of Medicine, Faculty of Medicine, Kaunas, Lithuania


Irritable bowel syndrome (IBS) is a chronic disorder of the gastrointestinal tract, characterized by abdominal pain and altered bowel habit. The clinical severity largely varies, ranging from episodic mild pain up to severe daily symptoms, associated with psychological distress and a drop in quality of life. Post-infectious irritable bowel syndrome (PI-IBS) is a common disorder when symptoms of IBS begin after an episode of acute gastroenteritis. IBS prevalence is reported in the range of 7-16%, the incidence of new IBS 12 months after the infection was 10.1%. The incidence appears higher after parasitic or protozoan infections at 49% compared to 13.8% after bacterial gastroenteritis. The risk of developing PI-IBS is associated with the severity of acute intestinal infection, duration of diarrhea, younger age, anxiety, depression and the female gender. The pathogenesis of IBS is not entirely clear. It is thought that several factors may contribute to its development. Significant changes in intestinal microflora were observed in IBS: a decrease in coliform bacteria, Lactobacillus spp., Bifidobacterium spp. and an increase in other organisms (e.g. Enterobacteriaceae). It is thought that gene polymorphism may influence the development of PI-IBS by increasing TNF-α concentration and decreasing IL-10 expression. Mast cells and enterochromaffin cells may increase visceral sensitivity and thus affect the onset of IBS symptoms. The PI-IBS pain can be caused by the slow recovery of damaged enteric nerves after infection. PI-IBS is diagnosed based on diagnostic criteria (Rome IV). The primary treatment for PI-IBS, as well as IBS, is symptomatic because the exact pathogenesis of this disease has not been elucidated. Treatment is focused on reassuring the patient and ensuring that the diagnosis is accurate. Treatment is given according to the patient’s individual symptoms, with the aim of ensuring a good quality of life and work capacity.

Keywords: post-infectious irritable bowel syndrome, irritable bowel syndrome, IBS, PI-IBS, acute gastroenteritis.