Post-diarrhea chronic intestinal symptoms and irritable bowel syndrome in North American travelers to Mexico.
OBJECTIVE
Irritable bowel syndrome (IBS) has been reported to complicate bacterial diarrhea. Because of the frequency of international travel and the common occurrence of bacterial diarrhea, we studied the occurrence of chronic gastrointestinal complaints and post-diarrhea IBS in North U.S. travelers to Mexico.


METHODS
One hundred and sixty-nine healthy students were followed prospectively for 5 wk for the occurrence and etiology of diarrhea while studying for 5 wk in Mexico. Subjects recorded their symptoms during travel and completed a gastrointestinal symptom questionnaire 6 months after returning to the United States to determine the presence of IBS using the Rome II criteria.


RESULTS
Ninety-seven (57%) subjects returned a completed questionnaire. Sixty-one (63%) developed diarrhea while in Mexico, mostly due to enterotoxigenic and enteroaggregative Escherichia coli. Six months after travel the following chronic symptoms were reported: loose stools, abdominal pain, and fecal urgency in 17 (18%), 17 (18%), and 9 (9%) respectively. Of the 60 patients surveyed who had acquired diarrhea in Mexico, 7 (11%) met the criteria for IBS 6 months later of which 6 (10%) were newly diagnosed. No identified pathogen in the initial illness was associated with the development of IBS.


CONCLUSIONS
Chronic gastrointestinal complaints including IBS are common in returning travelers having experienced diarrhea. Postinfectious complications of traveler's diarrhea require further study for etiology and strategy for prevention.
Division of Infectious Diseases, Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin, JFB 1.728, Houston, TX 77096, USA.
Pablo C
PC
Okhuysen
Zhi Dong
ZD
Jiang
Lily
L
Carlin
Charles
C
Forbes
Herbert L
HL
DuPont
D000328:Adult; D002908:Chronic Disease; D015331:Cohort Studies; D003109:Colonic Diseases, Functional / Q000453:epidemiology / Q000209:etiology; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D043183:Irritable Bowel Syndrome / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008800:Mexico; D009656:North America / Q000453:epidemiology; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D014195:Travel