title: Irritable bowel syndrome among a cohort of European travelers to resource-limited destinations.
abstract: BACKGROUND
  Travelers' diarrhea (TD) remains a frequent travel-associated infection. Between 4 and 32% of enteric infections were followed by a postinfectious irritable bowel syndrome (pIBS) with long-term sequelae in various settings. Travel-related IBS incidence rates are based on small studies and IBS predictors have not been sufficiently evaluated.
  
  
  METHODS
  Adult travelers to resource-limited destinations participated in a prospective questionnaire-based cohort study. Demographics, travel characteristics, and medical history were assessed and those with functional or organic gastrointestinal disorders were excluded. Immediately after return from abroad, the volunteers completed a second questionnaire on TD, other health impairments, and on nutritional hygiene. Six-months post-travel, a follow-up questionnaire assessed IBS based on Rome III criteria. Risk factors were analyzed by multiple logistic regression.
  
  
  RESULTS
  Among a total of 2,476 subjects analyzed (participation rate 72.4%), 38 (1.5%) developed new IBS, and the 6-month incidence rate for pIBS was 3.0% (95% CI 1.9-4.2) following TD. Significant risk factors were TD during the surveyed journey (OR 3.7; 95% 1.8-7.4), an adverse life event experienced within 12 months pre-travel (OR 3.1; 1.4-6.8), and a diarrheal episode experienced within 4 months pre-travel (OR 2.7; 95% CI 1.3-5.6). Following multiple diarrheal episodes, the risk of acquiring IBS increased by six times.
  
  
  CONCLUSIONS
  In a large population of European travelers IBS had a lower incidence rate as compared to previous studies. Particular risk groups were identified; those may need to be protected.
authors: Division of Epidemiology and Prevention of Communicable Diseases and World Health Organization Collaborating Centre for Travellers' Health, Institute of Social and Preventive Medicine, University of Zurich, Hirschengraben 84, Zurich, Switzerland.
authors: Raffaela
authors: R
authors: Pitzurra
authors: Michael
authors: M
authors: Fried
authors: Gerhard
authors: G
authors: Rogler
authors: Christina
authors: C
authors: Rammert
authors: Alois
authors: A
authors: Tschopp
authors: Christoph
authors: C
authors: Hatz
authors: Robert
authors: R
authors: Steffen
authors: Margot
authors: M
authors: Mutsch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D019049:Developed Countries; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D017678:Sex Distribution; D011795:Surveys and Questionnaires; D014195:Travel; D055815:Young Adult