title: Post-infectious irritable bowel syndrome: the past, the present and the future.
abstract: BACKGROUND
  Irritable bowel syndrome (IBS), once thought to be a psychosomatic disease, is being considered to be more organic. Post-infectious IBS (PI-IBS), defined as acute onset IBS (by Rome criteria) after gastrointestinal infection in an individual without prior IBS with two or more of the followings: fever, vomiting, diarrhea, a positive stool culture. The recent and old literature of PI-IBS will be reviewed. Future directions for research will be presented.
  
  
  METHODS
  Literature on PI-IBS was reviewed by electronic search and cross references of these papers.
  
  
  RESULTS
  Interest in studies on PI-IBS, which was described five to six decades ago, re-surfaced recently. 3.6 to 32% patients with acute gastroenteritis develop PI-IBS during 3-12 month follow-up. PI-IBS is commonly diarrhea predominant. Factors implicated in development include nature of pathogens, duration and severity of diarrhea, younger age, female gender and psychological co-morbidities like anxiety and depression. The pathogenesis of PI-IBS is largely related to continuing gut inflammation due to inability of the host to contain the inflammatory reaction, altered gut microbiota, increased intestinal permeability, muscle hyper-contractility and visceral hypersensitivity. There could be an overlap between PI-IBS and post-infectious malabsorption syndrome (PI-MAS), popularly known as tropical sprue.
  
  
  CONCLUSIONS
  Development of IBS in a subset of patients with acute gastroenteritis is uncontested. This is expected to open a paradigm shift in understanding the pathogenesis of IBS. Future studies should address the issue of overlap of PI-IBS and PI-MAS. Exploring the molecular mechanisms of pathogenesis of PI-IBS may help to design preventive and therapeutic strategies.
authors: Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. udayghoshal@gmail.com
authors: Uday C
authors: UC
authors: Ghoshal
authors: Prabhat
authors: P
authors: Ranjan
mesh_terms: D000208:Acute Disease; D001208:Asia / Q000453:epidemiology; D003141:Communicable Diseases / Q000150:complications* / Q000453:epidemiology / Q000266:history / Q000503:physiopathology; D005759:Gastroenteritis / Q000453:epidemiology / Q000209:etiology* / Q000266:history / Q000503:physiopathology; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000453:epidemiology / Q000209:etiology* / Q000266:history / Q000503:physiopathology; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors