Distinctive clinical, psychological, and histological features of postinfective irritable bowel syndrome.
OBJECTIVE
Irritable bowel syndrome after gastroenteritis is well recognized. Our aim was to determine whether postinfective IBS (PI-IBS) has histological or clinical features that are distinct from those of IBS patients with no history of preceding infection.


METHODS
A total of 75 consecutive IBS outpatients and 36 healthy control subjects completed a questionnaire detailing symptoms, mode of onset, and previous psychiatric history. All underwent a full diagnostic workup including rectal biopsy, which included immunostaining and quantification for lamina propria or intraepithelial T lymphocytes, serotonin-containing enterochromaffin (EC), and mast cells. Patients were divided according to onset of symptoms into PI-IBS (n = 23) or non-PI-IBS (n = 52) patients.


RESULTS
Diarrhea predominance occurred more frequently in PI-IBS (70%) than in non-PI-IBS (42%) patients (p = 0.03). A history of previous treatment for anxiety or depression was present in 26% of PI-IBS patients compared to 54% of non-PI-IBS (p = 0.02). Biopsy results for all patients were normal using conventional criteria; however, quantification revealed that PI-IBS showed increased EC cells compared to those of non-PI-IBS patients (p = 0.017) and controls (p = 0.02). Lamina propria T lymphocytes were increased in PI-IBS (p = 0.026) and non-PI-IBS (p = 0.011) patients compared to controls. Mast cells were increased in non-PI-IBS patients (p = 0.054) compared to controls.


CONCLUSIONS
Individuals with PI-IBS are a clinically distinct subgroup characterized by diarrheal symptoms, less psychiatric illness, and increased serotonin-containing EC cells compared to those with non-PI-IBS.
Dunlop
Simon P
SP
Division of Divisions of Gastroenterology, University Hospital, Nottingham, United Kingdom.
Jenkins
David
D
Spiller
Robin C
RC
D000328:Adult; D001706:Biopsy; D002452:Cell Count; D003109:Colonic Diseases, Functional / Q000150:complications / Q000209:etiology* / Q000473:pathology / Q000523:psychology*; D003967:Diarrhea / Q000209:etiology; D004759:Enterochromaffin Cells / Q000378:metabolism / Q000473:pathology; D005260:Female; D005759:Gastroenteritis / Q000150:complications* / Q000382:microbiology*; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008407:Mast Cells / Q000473:pathology; D001523:Mental Disorders / Q000209:etiology*; D008875:Middle Aged; D012007:Rectum / Q000473:pathology*; D012701:Serotonin / Q000378:metabolism; D013601:T-Lymphocytes / Q000473:pathology
D012701:Serotonin