According to a systematic review and meta-analysis published in Gut, individuals with acute gastroenteritis have a greater than fourfold increased odds of developing postinfection irritable bowel syndrome (PI-IBS) and threefold odds of developing postinfection functional dyspepsia (PI-FD).

The authors wrote, “Disorders of gut-brain interaction may arise after acute gastroenteritis. Data on the influence of pathogen type on the risk of postinfection IBS (PI-IBS), as on postinfection functional dyspepsia (PI-FD), are limited.”

For this systematic review and meta-analysis, researchers examined data from 47 observational studies, which included 28,170 individuals. The objective was to ascertain the prevalence of PI-IBS and PI-FD following acute gastroenteritis. Eligible studies included ≥50 adults and reported the percentage of patients with IBS or FD within ≥3 months of an episode of acute gastroenteritis. A random effects model was employed to approximate prevalence and odd ratio (ORs) with a 95% CI.

The results revealed that the overall prevalence of PI-IBS and PI-FD were 14.5% and 12.7%, respectively, and IBS continued in 39.8% of subjects in the long term (>5 years follow-up) after diagnosis. There were also meaningfully higher odds of IBS (OR, 4.3) and FD (OR, 3.0) among individuals with acute gastroenteritis compared with nonexposed controls. Moreover, PI-IBS was most commonly linked with parasites (prevalence 30.1%) but in only two studies, followed by bacteria (18.3%) and viruses (10.7%) in 13 studies. Studies demonstrated that 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.

The results also revealed that 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).

The authors concluded, “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. 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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