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Published on: May 2, 2018
Sequelae of traveler's diarrhea: focus on postinfectious irritable bowel syndrome
1Division of Gastroenterology and Hepatology, Weill Medical College of Cornell University, New York-Presbyterian Hospital, The New York Center for Travel and Tropical Medicine, New York, NY, USA. bconnor@pol.net
Abstract:
Traveler's diarrhea is usually an acute, self-limited illness; however, in some patients, enteric symptoms can persist for weeks, months, or years. It has been estimated that up to 3% of patients with traveler's diarrhea have symptoms for >30 days. The differential diagnosis includes persistent infection, coinfection, temporary postinfection phenomena, or malabsorptive syndromes. Once these possibilities are excluded, and if symptoms persist, a diagnosis of postinfectious irritable bowel syndrome (PI-IBS) becomes more likely. PI-IBS has recently become a topic of considerable clinical and investigative interest, because evidence validating it as a diagnosis and elucidating its pathophysiological mechanisms has accumulated. Epidemiological evidence suggests that PI-IBS is a relatively common sequela of acute gastroenteritis. Experimental evidence suggests that chronic inflammation following acute bacterial infection has a pathophysiological role in the development of PI-IBS. A fuller understanding of these pathophysiological mechanisms will lead to a more directed therapeutic approach and, perhaps, a reevaluation of prophylaxis for traveler's diarrhea as a means of primary prevention of PI-IBS.
Insights
Persistent traveler's diarrhea can lead to postinfectious irritable bowel syndrome (PI-IBS). Chronic inflammation after bacterial infection plays a key role in PI-IBS development, impacting treatment and prevention strategies.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Immunology
Background:
- Traveler's diarrhea (TD) is typically acute but can persist, leading to chronic symptoms.
- A subset of TD patients (up to 3%) experience symptoms lasting over 30 days.
- Persistent symptoms warrant differential diagnosis, including infection, postinfectious phenomena, and malabsorption.
Purpose of the Study:
- To explore the diagnosis and pathophysiology of postinfectious irritable bowel syndrome (PI-IBS).
- To highlight PI-IBS as a likely diagnosis for persistent TD after other causes are excluded.
- To review current evidence on PI-IBS mechanisms and implications for treatment and prevention.
Main Methods:
- Literature review of epidemiological and experimental studies on TD and PI-IBS.
- Analysis of diagnostic criteria for PI-IBS.
- Examination of pathophysiological mechanisms, including chronic inflammation.
Main Results:
- Postinfectious irritable bowel syndrome (PI-IBS) is increasingly recognized as a common sequela of acute gastroenteritis.
- Evidence supports chronic inflammation following bacterial infection as a key mechanism in PI-IBS.
- Exclusion of other causes is crucial for diagnosing PI-IBS in persistent TD.
Conclusions:
- PI-IBS is a significant condition following traveler's diarrhea.
- Understanding PI-IBS pathophysiology can guide therapeutic strategies.
- Prophylaxis for TD may be reconsidered for PI-IBS primary prevention.
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