Does Entamoeba histolytica cause irritable bowel syndrome?
BACKGROUND
Symptoms of patients with irritable bowel syndrome (IBS) closely mimic those of patients with non-dysenteric amebic colitis.


OBJECTIVE
To examine the clinical relevance of presence and types of Entamoeba histolytica in stools of patients with IBS.


METHODS
IBS was diagnosed by Manning's criteria. Stool examination was done 4-weekly for 48 weeks to detect E. histolytica cysts or trophozoites. Patients underwent initial sigmoidoscopy. Sera of 22 IBS patients, 23 asymptomatic cyst passers and 36 healthy volunteers whose stools were also examined were tested for presence of antiamebic antibodies. Stools were cultured for amebae; positive cultures were subjected to polyacrylamide-gel electrophoresis (PAGE) using hexokinase (HK) isoenzyme to distinguish between pathogenic (fast-moving band) E. histolytica infection and nonpathogenic (slow band) species of Entamoeba dispar.


RESULTS
E. histolytica cultured from stool samples of four IBS patients had slow-moving band of HK on PAGE. All patients spontaneously eradicated the infection during the next eight to 24 weeks; all had negative serology for antiamebic antibodies, and normal rectal mucosa on sigmoidoscopy. No change in symptom score occurred on follow up in IBS patients, although all of them cleared the infection. Three additional E. histolytica isolates from IBS patients obtained from another laboratory also showed nonpathogenic isoenzyme pattern.


CONCLUSIONS
Bowel symptoms in IBS patients were not related to E. histolytica infection. The term non-dysenteric amebic colitis thus appears to be inappropriate, since it may be used erroneously for patients with IBS with nonpathogenic ameba, leading to injudicious treatment with antiamebic drugs.
Sinha
P
P
Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow.
Ghoshal
U C
UC
Choudhuri
G
G
Naik
S
S
Ayyagari
A
A
Naik
S R
SR
D015746:Abdominal Pain / Q000209:etiology*; D000328:Adult; D000818:Animals; D003109:Colonic Diseases, Functional / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D003906:Developing Countries; D003937:Diagnosis, Differential; D004748:Entamoeba histolytica; D004749:Entamoebiasis / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D005243:Feces / Q000469:parasitology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India / Q000453:epidemiology; D007918:Leprosy / Q000534:rehabilitation; D008297:Male; D010270:Parasite Egg Count; D012047:Rehabilitation Centers