title: Postinfectious irritable bowel syndrome after travelers' diarrhea--a cohort study.
abstract: BACKGROUND
  There is sound evidence for the role of gastrointestinal infections in the development of postinfectious irritable bowel syndrome (PI-IBS), but understanding the interaction between mental factors and the infection remains incomplete. This study aims to (i) assess the occurrence of PI-IBS in a cohort of patients with self-reported travelers' diarrhea (TD), (ii) assess risk factors for PI-IBS development, and (iii) investigate the prognosis of PI-IBS after 1 year.
  
  
  METHODS
  Patients consulting the travel clinic at the University Hospital Tuebingen, Germany (in 2009 and 2010) were identified from records and questioned in follow-ups in 2011 and 2012. We used the Rome III modular questionnaire to assess IBS, the Hospital Anxiety and Depression Scale to assess anxiety and depression, and the Patient Health Questionnaire to assess somatization.
  
  
  RESULTS
  We identified 529 eligible subjects from the clinical records. Of 135 subjects (age: 36.6 ± 14.6 years, 58.5% female) included in the study sample 6.7% (95% CI 3.0-11.1) had PI-IBS. We found more females (88.9% vs 56.3%, p = 0.08) and younger age subjects (mean 29.3 vs 37.1 years, p = 0.02) among the PI-IBS subjects. A multivariable regression model revealed vomiting at baseline and high somatization scores as strong and independent PI-IBS risk factors. One year later PI-IBS occurrence decreased to 3.3% (three cases of 90).
  
  
  CONCLUSIONS
  Our findings underline the close linkage of mental and somatic processes for the manifestation of PI-IBS. Screening for psychiatric comorbidities in patients with severe gastrointestinal infections may allow identifying groups at high risk for PI-IBS.
authors.affiliation: Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Schwille-Kiuntke
authors.affiliation: Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Enck
authors.affiliation: Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.|Department of Internal Medicine, University of Gothenburg, Gothenburg, Sweden.
authors.forename: A V
authors.initials: AV
authors.lastname: Polster
authors.affiliation: Department of Internal Medicine VII: Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Gaile
authors.affiliation: Department of Internal Medicine VII: Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany.
authors.forename: P G
authors.initials: PG
authors.lastname: Kremsner
authors.affiliation: Department of Internal Medicine VII: Institute of Tropical Medicine, University Hospital Tübingen, Tübingen, Germany.|Institute of Public Health, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Zanger
mesh_terms: D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D003967:Diarrhea / Q000453:epidemiology* / Q000469:parasitology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000469:parasitology* / Q000523:psychology; D008297:Male; D012307:Risk Factors; D012737:Sex Factors
keywords: enteritis; postinfectious sequela; travel-related disease