A meta-analysis suggests a surprisingly high prevalence of this association.

Many studies have documented that irritable bowel syndrome (IBS) sometimes follows an episode of acute gastroenteritis caused by bacterial, viral or parasitic pathogens. A smaller body of literature suggests a similar link between acute gastroenteritis and functional dyspepsia. In this meta-analysis of 47 observational studies (28,000 patients), researchers estimated the prevalence of IBS and functional dyspepsia at more than three months after an episode of acute gastroenteritis. Forty-six studies reported prevalence of IBS, and 14 reported prevalence of functional dyspepsia. Most studies classified these disorders according to various iterations of the Rome criteria.

The overall prevalence of postinfectious IBS was 14.5%. In 22 case-control studies, the odds ratio for the association between acute gastroenteritis and IBS was 4.3. Most patients had diarrhoea-predominant or mixed IBS. In four studies, 40% of patients with IBS had persistent symptoms at five years after their gastroenteritis episodes.

The overall prevalence of post-infectious functional dyspepsia was 12.7%. In nine case-control studies, the odds ratio for the association between acute gastroenteritis and functional dyspepsia was 3.0. Data on long-term persistence of symptoms were not available.

Comment: The pathophysiology of a link between acute infectious gastroenteritis and IBS or functional dyspepsia is not well understood, and we do not know what proportion of these chronic disorders of the ‘gut-brain axis’ are preceded by infectious gastroenteritis. Although the existence of this link has no immediate implication for treatment, I have had several patients who developed IBS after acute gastroenteritis and who found it somewhat reassuring to learn that this sequence has been described in the medical literature.

Allan S. Brett, MD, Clinical Professor of Medicine, University of Colorado School of Medicine, Aurora, USA.

Porcari S, et al. Prevalence of irritable bowel syndrome and functional dyspepsia after acute gastroenteritis: systematic review and meta-analysis. Gut 2024; 73: 1431-1440.

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Gastroenterology.