Association between Acute Gastrointestinal Infection and Irritable Bowel Syndrome: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 ZHANGWei ¹ , WUXiao-liang ² , JIAODai-yan ¹ , CHENLu ² , PEILi-xia ² ,  SUNJian-hua ²

1. Second Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing 210029, China;
2. Department of Acupuncture and Rehabilitation, Jiangsu Province Hospital of Traditional Chinese Medicine, Nanjing 210029, China;

Corresponding author：

SUNJian-hua, Email: drjhsun@sina.com

Keywords：

Acute gastrointestinal infection; Irritable bowel syndrome; Systematic review; Meta-analysis; Cohort study

DOI：

10.7507/1672-2531.20140100

Video：

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Objective To systematically review the correlation between acute gastrointestinal infection and IBS. Methods Literature search was performed in The Cochrane Library (Issue 8, 2013), PubMed, EMbase, Web of Science, CBM, CNKI, VIP and WanFang Data to collect the prospective cohort studies about association between acute gastrointestinal infection and IBS, from inception to August 2013. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the quality using NOS, and then Meta analysis was conducted using RevMan 5.2 software. Results A total of 11 cohort studies involving 6 274 patients were included. According to the different follow-up times for subgroup analysis, the results of meta-analysis showed that, compared with the healthy volunteers who did not expose the acute gastrointestinal infection, the patients with acute gastroenteritis had a increase risk of irritable bowel syndrome within 3 months, 6 months, 12 months, and 2-3 years (3 months: RR=6.46, 95%CI 1.85 to 22.58, P=0.003; 6 months: RR=4.68, 95%CI 2.07 to 10.60, P=0.000 2; 12 months: RR=4.95, 95%CI 2.90 to 8.45, P < 0.000 01; 2-3 years: RR=3.11, 95%CI 2.72 to 3.56, P < 0.000 01). However, after the fifth year of acute gastroenteritis, there was no statistical significance in the risk of irritable bowel syndrome between the two groups (RR=1.69, 95%CI 0.68 to 4.24, P=0.26). Conclusion Acute gastrointestinal infection within 3 years after onset was associated with the risk of IBS. Sex, diarrhea duration, bloody purulent stools and abdominal cramps at acute stage are important risk factors of intriguing the occurrence of post-infectious IBS. The acute gastrointestinal infection and IBS are not associated in the fifth year; however, more high-quality trials are needed for further verifying the aforementioned conclusion.

Citation： ZHANGWei, WUXiao-liang, JIAODai-yan, CHENLu, PEILi-xia, SUNJian-hua. Association between Acute Gastrointestinal Infection and Irritable Bowel Syndrome: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2014, 14(5): 604-610. doi: 10.7507/1672-2531.20140100 Copy

1.	Zhao Y, Zou D, Wang R, et al. Dyspepsia and irritable bowel syndrome in China:a population-based endoscopy study of prevalence and impact. Aliment Parmacol Ther, 2010, 32(4):562-572.
2.	Dong YY, Zuo XL, Li CQ, et al. Prevalence of irritable bowel syndrome in Chinese college and university students assessed using Rome III criteria. World J Gastroenterol, 2010, 16(33):4221-4226.
3.	Lau EM, Chan FK, Ziea ET, et al. Epidemiology of irritable bowel syndrome in Chinese. Dig Dis Sci, 2002, 47(11):2621-2624.
4.	Krogsgaard LR, Engsbro AL, Bytzer P. The epidemiology of irritable bowel syndrome in Denmark. A population-based survey in adults≤50 years of age. Scand J Gastroenterol, 2013, 48(5):523-529.
5.	Saito YA, Schoenfeld P, Locke GR 3rd. The epidemiology of irritable syndrome in North America:a systematic review. Am J Gastroenterol, 2002, 97(8):1910-1915.
6.	Spiller R, Garsed K. Postinfectious irritable bowel syndrome. Gastroenterology, 2009, 136(6):1979-1988.
7.	Barbara G, Cremon C, Pallotti F, et al. Postinfectious irritable bowel syndrome. J Pediatr Gatroenter ol Nutr, 2009, (Suppl 2):S95-S97.
8.	Thabane M, Mashall JK. Post-infectious irritable bowel syndrome. World J Gastroenterol, 2009, 15(29):3591-3596.
9.	Thabane M, Kottachchi DT, Marshall JK. Systematic review and meta-analysis:The incidence and prognosis of post-infectious irritable bowel syndrome. Aliment Pharmacol Ther, 2007, 26(4):535-544.
10.	Halvorson HA, Schlett CD, Riddle MS. Postinfectious irritable bowel syndrome-a meta-analysis. Am J Gastroenterol, 2006, 101(8): 1894-1899.
11.	Manning AP, Thompson WG, Heaton KW, et al. Towards positive diagnosis of the irritable bowel syndrome. Br Med J, 1978, 2(6138): 653-654.
12.	Drossman DA. Irritable bowel syndrome. Am Fam Physician, 1989, 39(6):159-164.
13.	Hammer J, Talley NJ. Diagnostic criteria for the irritable bowel syndrome. Am J Med, 1999, 107(5A):5S-11S.
14.	Drossman DA, Dumirascu DL. Rome Ⅲ:new standard for functional gastrointestinal disorders. J Gastrointestin Liver Dis, 2006, 15(3):237-241.
15.	Stang A. Critical evaluation of the Newcastle-Ottawa Scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9):603-605.
16.	Soyturk M, Akpinar H, Gurler O, et al. Irritable bowel syndrome in persons who acquired trichinellosis. Am J Gastroenterol, 2007, 102(5):1064-1069.
17.	Jung IS, Kim HS, Park H, et al. The clinical course of postinfectious irritable bowel syndrome:a five-year follow-up study. J Clin Gastroenterol, 2009, 43(6):524-540.
18.	Zanini B, Ricci C, Bandera F, et al. Incidence of post-infectious irritable bowel syndrome and functional intestinal disorders following a water-borne viral gastroenteritis outbreak. Am J Gastroenterol, 2012, 107(6):891-899.
19.	Wensaas KA, Langeland N, Hanevik K, et al. Irritable bowel syndrome and chronic fatigue 3 years after acute giardiasis:historic cohort study. Gut, 2012, 61(2):214-219.
20.	Parry SD, Stansfield R, Jelley D, et al. Does bacterial gastroenteritis people to functional gastrointestinal disorders? A prospective, community-based, case-control study. Am J Gastroenterol, 2003, 98(9): 1970-1975.
21.	Wang LH, Fang XC, Pan GZ. Bacillary dysentery as causative factor of irritable bowel syndrome and its pathogenesis. Gut, 2004, 53(8): 1096-1101.
22.	Mearin F, Perez-Oliveras M, Perello A, et al. Dyspepsia and irritable bowel syndrome after a Sallmonella gastroenteritis outbreak:oneyear follow-up cohort study. Gastroenterology, 2005, 129(1):98-104.
23.	Ji S, Park H, Lee D, et al. Post-infectious irritable bowel syndrome in patients with Shigella infection. J Gastroenterol Hepatol, 2005, 20(3): 381-386.
24.	Marshall JK, Thabane M, Garg AX, et al. Incidence and epidemiology of irritable bowel syndrome after a large waterborne outbreak of bacterial dysentery. Gastroenterology, 2006, 131(2):445-450.
25.	McKeown ES, Parry SD, Stansfield R, et al. Postinfectious irritable bowel syndrome may occur after non-gastrointestinal and intestinal infection. Neurogastroenterol Motil, 2006, 18(9):839-843.
26.	Marshall JK, Thabane M, Borgaokar MR, et al. Postinfectious irritable bowel syndrome after a food-borne outbreak of acute gastroenteritis attributed to a viral pathogen. Clin Gastroenterol Hepatol, 2007, 5(4):457-460.
27.	Neal KR, Barker L, Spiller RC. Prognosis in post-infective irritable bowel syndrome:a six year follow up study. Gut, 2002, 51(3):410-413.
28.	Youn YH, Park SY, Park CI, et al. The clinical course of postinfectious irritable bowel syndrome(IBS) after shigellosis:A 10-year follow-up study. Neurogastroenterol Motil, 2012, S2:102.
29.	Mashall JK, Thabane M, Garg AX, et al. Eight year prognosis of postinfectious irritable bowel syndrome following waterborne bacterial dysentery. Gut, 2010, 59(5):605-611.
30.	Moss-Morris R, Spence M. To "lump" or to "split" the functional somatic syndromes:can infectious and emotional risk factors differentiate between the onset of chronic fatigue syndrome and irritable bowel syndrome? Psychosom Med, 2006, 68(3):463-469.
31.	Spence MJ, Moss-Morris R. The cognitive behavioural model of irritable bowel syndrome:a prospective investigation of patients with gastroenteritis. Gut, 2007, 56(8):1066-1071.
32.	Bashashati M, Rezaei N, Bashashati H, et al. Cytokine gene polymorphisms are associated with irritable bowel syndrome:a systematic review and meta-analysis. Neurogastroenterol Motil, 2012, 24(12): 1102-e566.
33.	Thornley JP, Jenkins D, Neal K, et al. Relationship of Campylobacter toxigenicity in vitro to the development of postinfectious irritable bowel syndrome. J Infect Dis, 2001, 184(5):606-609.
34.	Whitehead WE, Drossman DA. Validation of symptom-based diagnostic criteria for irritable bowel syndrome:a critical review. Am J Gastroenterol, 2010, 105(4):814-820.

1. Zhao Y, Zou D, Wang R, et al. Dyspepsia and irritable bowel syndrome in China:a population-based endoscopy study of prevalence and impact. Aliment Parmacol Ther, 2010, 32(4):562-572.
2. Dong YY, Zuo XL, Li CQ, et al. Prevalence of irritable bowel syndrome in Chinese college and university students assessed using Rome III criteria. World J Gastroenterol, 2010, 16(33):4221-4226.
3. Lau EM, Chan FK, Ziea ET, et al. Epidemiology of irritable bowel syndrome in Chinese. Dig Dis Sci, 2002, 47(11):2621-2624.
4. Krogsgaard LR, Engsbro AL, Bytzer P. The epidemiology of irritable bowel syndrome in Denmark. A population-based survey in adults≤50 years of age. Scand J Gastroenterol, 2013, 48(5):523-529.
5. Saito YA, Schoenfeld P, Locke GR 3rd. The epidemiology of irritable syndrome in North America:a systematic review. Am J Gastroenterol, 2002, 97(8):1910-1915.
6. Spiller R, Garsed K. Postinfectious irritable bowel syndrome. Gastroenterology, 2009, 136(6):1979-1988.
7. Barbara G, Cremon C, Pallotti F, et al. Postinfectious irritable bowel syndrome. J Pediatr Gatroenter ol Nutr, 2009, (Suppl 2):S95-S97.
8. Thabane M, Mashall JK. Post-infectious irritable bowel syndrome. World J Gastroenterol, 2009, 15(29):3591-3596.
9. Thabane M, Kottachchi DT, Marshall JK. Systematic review and meta-analysis:The incidence and prognosis of post-infectious irritable bowel syndrome. Aliment Pharmacol Ther, 2007, 26(4):535-544.
10. Halvorson HA, Schlett CD, Riddle MS. Postinfectious irritable bowel syndrome-a meta-analysis. Am J Gastroenterol, 2006, 101(8): 1894-1899.
11. Manning AP, Thompson WG, Heaton KW, et al. Towards positive diagnosis of the irritable bowel syndrome. Br Med J, 1978, 2(6138): 653-654.
12. Drossman DA. Irritable bowel syndrome. Am Fam Physician, 1989, 39(6):159-164.
13. Hammer J, Talley NJ. Diagnostic criteria for the irritable bowel syndrome. Am J Med, 1999, 107(5A):5S-11S.
14. Drossman DA, Dumirascu DL. Rome Ⅲ:new standard for functional gastrointestinal disorders. J Gastrointestin Liver Dis, 2006, 15(3):237-241.
15. Stang A. Critical evaluation of the Newcastle-Ottawa Scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9):603-605.
16. Soyturk M, Akpinar H, Gurler O, et al. Irritable bowel syndrome in persons who acquired trichinellosis. Am J Gastroenterol, 2007, 102(5):1064-1069.
17. Jung IS, Kim HS, Park H, et al. The clinical course of postinfectious irritable bowel syndrome:a five-year follow-up study. J Clin Gastroenterol, 2009, 43(6):524-540.
18. Zanini B, Ricci C, Bandera F, et al. Incidence of post-infectious irritable bowel syndrome and functional intestinal disorders following a water-borne viral gastroenteritis outbreak. Am J Gastroenterol, 2012, 107(6):891-899.
19. Wensaas KA, Langeland N, Hanevik K, et al. Irritable bowel syndrome and chronic fatigue 3 years after acute giardiasis:historic cohort study. Gut, 2012, 61(2):214-219.
20. Parry SD, Stansfield R, Jelley D, et al. Does bacterial gastroenteritis people to functional gastrointestinal disorders? A prospective, community-based, case-control study. Am J Gastroenterol, 2003, 98(9): 1970-1975.
21. Wang LH, Fang XC, Pan GZ. Bacillary dysentery as causative factor of irritable bowel syndrome and its pathogenesis. Gut, 2004, 53(8): 1096-1101.
22. Mearin F, Perez-Oliveras M, Perello A, et al. Dyspepsia and irritable bowel syndrome after a Sallmonella gastroenteritis outbreak:oneyear follow-up cohort study. Gastroenterology, 2005, 129(1):98-104.
23. Ji S, Park H, Lee D, et al. Post-infectious irritable bowel syndrome in patients with Shigella infection. J Gastroenterol Hepatol, 2005, 20(3): 381-386.
24. Marshall JK, Thabane M, Garg AX, et al. Incidence and epidemiology of irritable bowel syndrome after a large waterborne outbreak of bacterial dysentery. Gastroenterology, 2006, 131(2):445-450.
25. McKeown ES, Parry SD, Stansfield R, et al. Postinfectious irritable bowel syndrome may occur after non-gastrointestinal and intestinal infection. Neurogastroenterol Motil, 2006, 18(9):839-843.
26. Marshall JK, Thabane M, Borgaokar MR, et al. Postinfectious irritable bowel syndrome after a food-borne outbreak of acute gastroenteritis attributed to a viral pathogen. Clin Gastroenterol Hepatol, 2007, 5(4):457-460.
27. Neal KR, Barker L, Spiller RC. Prognosis in post-infective irritable bowel syndrome:a six year follow up study. Gut, 2002, 51(3):410-413.
28. Youn YH, Park SY, Park CI, et al. The clinical course of postinfectious irritable bowel syndrome(IBS) after shigellosis:A 10-year follow-up study. Neurogastroenterol Motil, 2012, S2:102.
29. Mashall JK, Thabane M, Garg AX, et al. Eight year prognosis of postinfectious irritable bowel syndrome following waterborne bacterial dysentery. Gut, 2010, 59(5):605-611.
30. Moss-Morris R, Spence M. To "lump" or to "split" the functional somatic syndromes:can infectious and emotional risk factors differentiate between the onset of chronic fatigue syndrome and irritable bowel syndrome? Psychosom Med, 2006, 68(3):463-469.
31. Spence MJ, Moss-Morris R. The cognitive behavioural model of irritable bowel syndrome:a prospective investigation of patients with gastroenteritis. Gut, 2007, 56(8):1066-1071.
32. Bashashati M, Rezaei N, Bashashati H, et al. Cytokine gene polymorphisms are associated with irritable bowel syndrome:a systematic review and meta-analysis. Neurogastroenterol Motil, 2012, 24(12): 1102-e566.
33. Thornley JP, Jenkins D, Neal K, et al. Relationship of Campylobacter toxigenicity in vitro to the development of postinfectious irritable bowel syndrome. J Infect Dis, 2001, 184(5):606-609.
34. Whitehead WE, Drossman DA. Validation of symptom-based diagnostic criteria for irritable bowel syndrome:a critical review. Am J Gastroenterol, 2010, 105(4):814-820.

Chinese Journal of Evidence-Based Medicine

Association between Acute Gastrointestinal Infection and Irritable Bowel Syndrome: A Meta-Analysis

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