Small Bowel
Almost All Irritable Bowel Syndromes Are Post-Infectious and Respond to Probiotics: Controversial Issues
Giovanni Barbara, Vincenzo Stanghellini, Cesare Cremon, Roberto De Giorgio, Roberto Corinaldesi
Department of Internal Medicine and Gastroenterology, University of Bologna, Bologna, Italy
Address of Corresponding Author
Dig Dis 2007;25:245-248 (DOI: 10.1159/000103894)
Key Words
- Acute infectious gastroenteritis
- Irritable bowel syndrome
- Post-infectious irritable bowel syndrome
- Intestinal microflora, role
- Irritable bowel syndrome, clinical management
Abstract
Acute infectious gastroenteritis is the strongest known risk factor for the development of irritable bowel syndrome (IBS), one of the most common functional gastrointestinal disorders. However, knowledge about the incidence and prevalence of post-infectious IBS (PI-IBS) in the general population is still limited. Some of the published epidemiological studies on PI-IBS lack an appropriate control population, and were limited by a short follow-up symptom assessment post-infection. A number of risk factors have been associated with the development of PI-IBS, including the virulence of the pathogen, younger age, female sex, the long duration of the initial illness and the presence of psychological disturbances. However, much work has to be done to establish whether multifactorial mechanisms actually concur to the pathophysiology of PI-IBS. The discovery that an infective episode may trigger the development of IBS has not substantially changed the clinical management of this subset of patients compared to the classical (non-infective) form of IBS. Probiotics have been claimed to be of some benefit in IBS, but the majority of studies have been performed in non-specific IBS rather than in PI-IBS and a number of issues still remain to be elucidated. Copyright © 2007 S. Karger AG, Basel
References
- 1.
- Chaudhary NA, Truelove SC: The irritable colon syndrome. A study of the clinical features, predisposing causes, and prognosis in 130 cases. Q J Med 1962;31:307-322.

- 2.
- Longstreth GF, Hawkey CJ, Mayer EA, Jones RH, Naesdal J, Wilson IK, Peacock RA, Wiklund IK: Characteristics of patients with irritable bowel syndrome recruited from three sources: implications for clinical trials. Aliment Pharmacol Ther 2001;15:959-964.

- 3.
- Wang LH, Fang XC, Pan GZ: Bacillary dysentery as a causative factor of irritable bowel syndrome and its pathogenesis. Gut 2004;53:1096-1101.

- 4.
- Ji S, Park H, Lee D, Song YK, Choi JP, Lee SI: Post-infectious irritable bowel syndrome in patients with Shigella infection. J Gastroenterol Hepatol 2005;20:381-386.

- 5.
- Collins SM, Barbara G: East meets West: infection, nerves, and mast cells in the irritable bowel syndrome. Gut 2004;53:1068-1069.

- 6.
- Anand AC, Reddy PS, Saiprasad GS, Kher SK: Does non-dysenteric intestinal amoebiasis exist? Lancet 1997;349:89-92.

- 7.
- Nanda R, Baveja U, Anand BS: Entamoeba histolytica cyst passers: clinical features and outcome in untreated subjects. Lancet 1984;2:301-303.

- 8.
- Sinha P, Ghoshal UC, Choudhuri G, Naik S, Ayyagari A, Naik SR: Does Entamoeba histolytica cause irritable bowel syndrome? Indian J Gastroenterol 1997;16:130-133.

- 9.
- Gwee KA: Irritable bowel syndrome in developing countries - a disorder of civilization or colonization? Neurogastroenterol Motil 2005;17:317-324.

- 10.
- Spiller RC: Postinfectious irritable bowel syndrome. Gastroenterology 2003;124:1662-1671.

- 11.
- Barbara G, De Giorgio R, Stanghellini V, Cremon C, Salvioli B, Corinaldesi R: New pathophysiological mechanisms in irritable bowel syndrome. Aliment Pharmacol Ther 2004;20(suppl 2):1-9.

- 12.
- Neal KR, Hebden J, Spiller R: Prevalence of gastrointestinal symptoms six months after bacterial gastroenteritis and risk factors for development of the irritable bowel syndrome: postal survey of patients. BMJ 1997;314:779-782.

- 13.
- Barbara G, Stanghellini V, Berti-Ceroni C, De Giorgio R, Salvioli B, Corradi F, Cremon C, Corinaldesi R: Role of antibiotic therapy on long-term germ excretion in faeces and digestive symptoms after Salmonella infection. Aliment Pharmacol Ther 2000;14:1127-1131.

- 14.
- Isgar B, Harman M, Kaye MD, Whorwell PJ: Symptoms of irritable bowel syndrome in ulcerative colitis in remission. Gut 1983;24:190-192.

- 15.
- Fine KD, Meyer RL, Lee EL: The prevalence and causes of chronic diarrhea in patients with celiac sprue treated with a gluten-free diet. Gastroenterology 1997;112:1830-1838.

- 16.
- Barbara G, Stanghellini V, Brandi G, Cremon C, Di Nardo G, De Giorgio R, Corinaldesi R: Interactions between commensal bacteria and gut sensorimotor function in health and disease. Am J Gastroenterol 2005;100:2560-2568.

- 17.
- Niaz SK, Sandrasegaran K, Renny FH, Jones BJ: Postinfective diarrhoea and bile acid malabsorption. J R Coll Physicians Lond 1997;31:53-56.

- 18.
- Dunlop SP, Jenkins D, Neal KR, Naesdal J, Borgaonker M, Collins SM, Spiller RC: Randomized, double-blind, placebo-controlled trial of prednisolone in post-infectious irritable bowel syndrome. Aliment Pharmacol Ther 2003;18:77-84.

- 19.
- Pimentel M, Park S, Mirocha J, Kane SV, Kong Y: The effect of a nonabsorbed oral antibiotic (rifaximin) on the symptoms of the irritable bowel syndrome: a randomized trial. Ann Intern Med 2006;145:557-563.

- 20.
- Neal KR, Barker L, Spiller RC: Prognosis in post-infective irritable bowel syndrome: a six-year follow-up study. Gut 2002;51:410-413.

Author Contacts Giovanni Barbara, MD Department of Internal Medicine and Gastroenterology St. Orsola-Malpighi Hospital, Building No. 5 Via Massarenti, 9, IT-40138 Bologna (Italy) Tel. +39 051 636 4103, Fax +39 051 345 864, E-Mail giovanni.barbara@unibo.it
Article Information
Number of Print Pages : 4
Number of Figures : 0, Number of Tables : 0, Number of References : 20
Publication Details
Digestive Diseases (Clinical Reviews)
Vol. 25, No. 3, Year 2007 (Cover Date: September 2007)
Journal Editor: Malfertheiner, P. (Magdeburg)
ISSN: 0257-2753 (print), 1421-9875 (Online) For additional information: http://www.karger.com/DDI
Drug Dosage / Copyright Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center. |
|
|