title: 'Holiday sickness'-reported exploratory outcome of over 500 United Kingdom holidaymakers with travellers' diarrhoea.
abstract: OBJECTIVE
  To ascertain any predictors of potential food poisoning pathogens and development of post-infective irritable bowel syndrome (IBS) in UK travellers. An analysis was undertaken on prospectively collected data on 527 patients reporting symptoms of suspected food poisoning between June 2012 and June 2015.
  
  
  METHODS
  Positive stool sample indicative of food poisoning pathogens and diagnosis of post-infective IBS.
  
  
  RESULTS
  Data on 527 patients were examined. The large majority of patients did not provide a stool sample on return from holiday (n = 430, 81.6%) as few visited a Doctor locally or in the UK. Only 18 patients (18.6%, 95% confidence interval [CI] 11.4-27.7) who provided a stool sample were positive for microbiological food poisoning pathogens. Univariate analysis indicated a significant relationship between a positive stool sample and whether the individual sought any medical assistance at the resort (odds ratio [OR] 0.24, 95% CI 0.08-0.70) and whether they took any treatment (including self-medicated), (OR 0.21, 95% CI 0.06-0.67). Of the 527 patients only 30 (5.7%, 95% CI 3.9-8.1) experienced post-infective IBS. Univariate regression indicated a significant relationship between experiencing Per Rectal (PR) bleeding and a diagnosis of post-infective IBS (OR 3.64, 95% CI 1.00-10.49). Univariate regression also indicated an increase in the risk of developing post-infective IBS with increasing duration of symptoms (OR 1.04, 95% CI 1.02-1.05). No significant relationship was found between a positive stool sample and developing post-infective IBS (P = 0.307).
  
  
  CONCLUSIONS
  Very few patients provide a stool sample after experiencing holiday sickness abroad. Of those that do, only a small proportion have a positive stool sample indicative of a food poisoning microorganism. Around 6% of individuals were diagnosed with post-infective IBS. Those individuals with PR bleeding and symptoms persisting for longer durations were significantly more at risk of developing post-infective IBS, whilst medical aid and treatment abroad was found to reduce the odds of a positive stool sample.
authors.affiliation: Department of Surgery, Central Manchester NHS Foundation Trust, Oxford Road, Manchester, UK aali.sheen@cmft.nhs.uk.|Department of Microbiology Research, School of Healthcare Sciences, Manchester Metropolitan University, Manchester, UK.
authors.forename: Prof Aali J
authors.initials: PA
authors.lastname: Sheen
authors.affiliation: Department of Surgery, Central Manchester NHS Foundation Trust, Oxford Road, Manchester, UK.
authors.forename: M Saad B
authors.initials: MS
authors.lastname: Zahid
authors.affiliation: Department of Paediatric Gastroenterology, Central Manchester NHS Foundation Trust, Oxford Road, Manchester, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Fagbemi
authors.affiliation: Centre for Biostatistics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.|Research & Innovation, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Fullwood
authors.affiliation: Department of Microbiology Research, School of Healthcare Sciences, Manchester Metropolitan University, Manchester, UK.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Whitehead
mesh_terms: D000328:Adult; D003967:Diarrhea / Q000453:epidemiology*; D005243:Feces / Q000382:microbiology*; D005260:Female; D005517:Foodborne Diseases / Q000150:complications*; D006693:Holidays; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014195:Travel; D006113:United Kingdom
keywords: Holiday sickness; abdominal cramps; abdominal pain; diarrhoea; irritable bowel syndrome; post-infective IBS; rectal bleeding (PR); sickness; travellers’; vomiting