What Is Post-Infectious IBS?

What You Need to Know About IBS-PI

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Many of us have experienced a "stomach bug" at some point. The typical symptoms of fever, vomiting, and diarrhea tend to clear up within a matter of days. Unfortunately, for some people, that return to health does not always happen as expected. 

In some cases, a person finds that symptoms linger and develop into a case of irritable bowel syndrome, or IBS. When this occurs, the condition is classified as post-infectious irritable bowel syndrome (IBS-PI).

What Is IBS-PI?

Post-infectious IBS can follow any number of gastrointestinal (GI) infections that occur in the stomach and intestines. These are typically bacterial in nature rather than those caused by a virus. Studies have estimated that about 10 percent of people dealing with IBS fall into this IBS-PI sub-type.

In many cases, people develop the diarrhea-predominant form of IBS, known as IBS-D. You might also get a mix of constipation and diarrhea symptoms, but constipation-predominant IBS (IBS-C) is rare in post-infectious causes.

IBS-PI is typically the only sub-type of IBS in which the cause can be identified.

What Are the Risk Factors for IBS-PI?

Research has identified several factors that may increase the risk that IBS-PI will develop following a GI infection.

  • The Severity of the Initial Infection. For the most part, IBS-PI is the result of a bacterial infection, such as food poisoning, rather than that of a virus. The toxicity of the particular bacteria, the length of time of the illness, and the severity of initial symptoms all affect the likelihood of developing IBS-PI. Treating the infection with antibiotics seems to increase the risk of IBS-PI as well.
  • Gender and Lifestyle. Women are at higher risk than males. Also, people who smoke seem to be more likely to develop IBS-PI.
  • Anxiety and Stress. IBS-PI appears to be more likely to develop in individuals who experienced higher levels of anxiety or stressful life events in the three months leading up to the initial infection. People with depression or hypochondriasis (illness anxiety disorder) are also at higher risk.
  • Activity Level. One research study found that individuals who remained active in spite of initial gastrointestinal symptoms were more likely to develop IBS-PI.

Yet, there also seems to be a couple of factors that may protect you from IBS-PI.  According to studies, individuals over the age of 60 face a lesser risk.  Similarly, research indicates that vomiting during the initial illness may cut the risk of IBS-PI by as much as 50 percent.

What’s Going On in There?

It is thought that during a GI infection, there is an increase in inflammatory cells in the lining of the intestines. Under typical circumstances, these cells decrease with time. Preliminary research into the matter suggests that this inflammatory response takes longer to dissipate in cases of IBS-PI. A higher numbers of these cells continue to be seen well after the initial infection.

How Is IBS-PI Treated?

As with all cases of IBS, treatment is generally focused on relieving specific symptoms. Options include the use of anti-diarrheal agents such as Imodium, probiotics, and the recommendation of a low-fiber diet.

What Is the Prognosis for IBS-PI?

The good news is that patients whose IBS is post-infectious have a more favorable prognosis than those for whom the origin of the IBS is unknown.

It is estimated that approximately half of all IBS-PI patients will return to a state of healthy digestive functioning. 

However, it may take years for IBS-PI symptoms to relinquish. Recovery is less likely to happen if there is co-existing anxiety or depression, thus treatment of these emotional symptoms becomes an important health priority.

Sources:

Saha L. Irritable Bowel Syndrome: Pathogenesis, Diagnosis, Treatment, and Evidence-Based Medicine. World Journal of Gastroenterology. 2014;20(22):6759-6773.

Spence M, Moss-Morris R. The Cognitive Behavioural Model of Irritable Bowel Syndrome: A Prospective Investigation of Patients With Gastroenteritis. Gut. 2007;56:1066-1071.

International Foundation for Functional Gastrointestinal Disorders Post-infectious IBS. 2016.

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