Post-infectious and non post-infectious irritable bowel syndrome: A comparative study

Contribution of sex and gender roles to the incidence of post-infectious irritable bowel syndrome in a prospective study

Post-infectious irritable bowel syndrome (PI-IBS) occurs in about 10% of cases following gastroenteritis. The incidence of IBS is higher in females. However, it is not clear whether this is due to biological or psychosocial factors. We aimed to investigate the influence of gender roles on the incidence of PI-IBS, alongside traditional risk factors. Our study included 231 patients diagnosed with gastroenteritis who were hospitalized and treated with antibiotics between 2018 and 2021. The Korean Sex Role Inventory-Short Form (KSRI-SF), based on the Bem Sex Role Inventory (BSRI) was used to categorize patients (androgynous, masculine, feminine, and undifferentiated types). Six months after treatment, we conducted a telephone survey to confirm the presence of PI-IBS using the ROME IV criteria. Among the patients, 43.3% were female, and the mean age was 43.67 ± 16.09 years. After 6 months, 34 patients developed PI-IBS. Univariate analysis revealed that younger age, female sex, KSRI-SF undifferentiated type, and longer duration of antibiotic use independently influenced the occurrence of PI-IBS. Multivariate analysis showed that PI-IBS was associated with the KSRI-SF undifferentiated type and higher C-reactive protein (CRP) levels. Our study showed that the KSRI-SF undifferentiated type and high CRP levels at initial infection were associated with PI-IBS.

Postinfection Irritable Bowel Syndrome Following Clostridioides difficile Infection: A Systematic-review and Meta-analysis

BACKGROUND

Postinfection irritable bowel syndrome (PI-IBS) affects ~14% patients after acute bacterial enterocolitis.

AIM

The aim of this study was to conduct a systematic review and meta-analysis to find the prevalence of PI-IBS following Clostridioides difficile infection (CDI).

METHODS

We systematically searched Medline, Embase, and Web of Science from inception through January 20, 2020 for cohort studies assessing PI-IBS following CDI. Primary outcome was pooled prevalence calculated using inverse variance heterogeneity model [MetaXL (v. 5.3)]. A priori subgroup analyses were done [by irritable bowel syndrome (IBS) diagnostic criteria-Rome vs. others, time of IBS diagnosis-<6 or >6 mo, exclusion or inclusion of pre-existing IBS and CDI treatment-antibiotic with fecal microbiota transplantation vs. antibiotic only]. Heterogeneity was considered substantial if I2>50%.

RESULTS

From 2007 to 2019, 15 studies were included (10 prospective, 5 retrospective; 9 full-text, 6 abstracts). Data from 1218 patients were included in the quantitative analysis. Risk of bias was low in 7, medium in 4 and high in 4 studies. Pooled prevalence of PI-IBS was 21.1% (95% confidence interval, 8.2%-35.7%), I2=96%. Common PI-IBS subtypes were diarrhea-predominant in 46.3% (50) patients, and mixed in 33.3% (36) patients. Subgroup analyses by IBS diagnostic criteria, time of IBS diagnosis or CDI treatment did not significantly change the primary outcome (all P>0.05), nor decrease heterogeneity. Funnel plot analysis revealed publication bias.

CONCLUSIONS

Over 20% of patients develop PI-IBS after CDI. Factors such as diagnostic criteria for IBS and CDI treatment did not affect prevalence, though small numbers limit the confidence in these conclusions. Larger, well conducted studies are needed to study PI-IBS in CDI.

COVID-19 as a trigger of irritable bowel syndrome: A review of potential mechanisms

In December 2019 a novel coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), started spreading from Wuhan city of Chinese Hubei province and rapidly became a global pandemic. Clinical symptoms of the disease range from paucisymptomatic disease to a much more severe disease. Typical symptoms of the initial phase include fever and cough, with possible progression to acute respiratory distress syndrome. Gastrointestinal manifestations such as diarrhoea, vomiting and abdominal pain are reported in a considerable number of affected individuals and may be due to the SARS-CoV-2 tropism for the peptidase angiotensin receptor 2. The intestinal homeostasis and microenvironment appear to play a major role in the pathogenesis of COVID-19 and in the enhancement of the systemic inflammatory responses. Long-term consequences of COVID-19 include respiratory disturbances and other disabling manifestations, such as fatigue and psychological impairment. To date, there is a paucity of data on the gastrointestinal sequelae of SARS-CoV-2 infection. Since COVID-19 can directly or indirectly affect the gut physiology in different ways, it is plausible that functional bowel diseases may occur after the recovery because of potential pathophysiological alterations (dysbiosis, disruption of the intestinal barrier, mucosal microinflammation, post-infectious states, immune dysregulation and psychological stress). In this review we speculate that COVID-19 can trigger irritable bowel syndrome and we discuss the potential mechanisms.

Role of Overweight and Obesity in Gastrointestinal Disease

The prevalence of obesity is increasing worldwide, leading to a severe impairment of overall health. Actually, obesity has been associated with several pathological conditions, causing an excess overall mortality. In particular, overweight and obesity are well known risk factors for a variety of gastrointestinal (GI) disorders i.e., functional GI disorders as well as, inflammatory bowel disease (IBD), pancreatitis, and GI cancer. The aim of the present review is to summarize the potential role of overweight and obesity in GI disease with particular focus on plausible biological mechanisms that could explain the association between obesity and GI disease based on the most recent evidence in the literature.

Phenotypic features of patients with post-infectious irritable bowel syndrome

Background

Although there are many published data in the literature about irritable bowel syndrome (IBS), there are only few data on the long term evolution of patients with post infectious irritable bowel syndrome (PI-IBS) and associated conditions.

Aims

The purpose of our research was to study the evolution of PI-IBS patients in a single tertiary center over a period of four years.

Study Design

Our research was a longitudinal retrospective study.

Methods

We carried out this study based on the survey of the patients records. We recruited two groups of patients: patients with classical IBS and patients with PI-IBS. The IBS diagnosis was established using ROME III criteria, which were used at that time. We compared the two groups of patients by analyzing the demographic data, comorbidities, treatment that was prescribed, and evolution after treatment for a period of 48 month on average.

Results

From a total of 592 patients that were diagnosed with IBS between 2013-2016, we identified a subgroup of 64 patients with PI-IBS. These patients were also divided into two subgroups, depending on the main symptoms, 51 with PI-IBS - diarrhea and 13 of them with PI-IBS-constipation. IBS is the most commonly diagnosed among women, 45 patients were women and 15 were men. Regarding the frequency of occurrence of a certain subtype by gender, no significant differences were observed in both IBS and PI-IBS. We noticed a higher incidence of patients residents of an urban community in both groups.The main symptoms were: abdominal pain and bowel disorders (constipation, diarrhea).There was a significant difference between the two groups regarding the onset of the symptoms. From the total of 64 patients with PI-IBS, 88.3% presented a sudden onset of symptoms (mainly abdominal pain) unlike the other group where 81% of them presented a progressive onset, with an insidious progress and sporadic exacerbation. Most patients (65.63%) presented an improvement after the treatment, 25.56% oscillating periods but with a significant decrease of intensity of symptoms, and 7.8% did not show improvement after treatment.The most common associated diseases were depression and anxiety (34.37%).

Conclusion

IBS is generally present in approximately 11% of the population, with PI-IBS patients accounting for approximately 10% of them. Female gender is more common in both IBS and PI-IBS. Patients with PI-IBS are a burden in the health system in terms of the important economic resources used for diagnosis and treatment.