title: Prevalence, Risk Factors, and Outcomes of Irritable Bowel Syndrome After Infectious Enteritis: A Systematic Review and Meta-analysis.
abstract: Foodborne illness affects 15% of the US population each year, and is a risk factor for irritable bowel syndrome (IBS). We evaluated risk of, risk factors for, and outcomes of IBS after infectious enteritis.
  
  
  
  We performed a systematic review of electronic databases from 1994 through August 31, 2015 to identify cohort studies of the prevalence of IBS 3 months or more after infectious enteritis. We used random-effects meta-analysis to calculate the summary point prevalence of IBS after infectious enteritis, as well as relative risk (compared with individuals without infectious enteritis) and host- and enteritis-related risk factors.
  
  
  
  We identified 45 studies, comprising 21,421 individuals with enteritis, followed for 3 months to 10 years for development of IBS. The pooled prevalence of IBS at 12 months after infectious enteritis was 10.1% (95% confidence interval [CI], 7.2-14.1) and at more than 12 months after infectious enteritis was 14.5% (95% CI, 7.7-25.5). Risk of IBS was 4.2-fold higher in patients who had infectious enteritis in the past 12 months than in those who had not (95% CI, 3.1-5.7); risk of IBS was 2.3-fold higher in individuals who had infectious enteritis more than 12 months ago than in individuals who had not (95% CI, 1.8-3.0). Of patients with enteritis caused by protozoa or parasites, 41.9% developed IBS, and of patients with enteritis caused by bacterial infection, 13.8% developed IBS. Risk of IBS was significantly increased in women (odds ratio [OR], 2.2; 95% CI, 1.6-3.1) and individuals with antibiotic exposure (OR, 1.7; 95% CI, 1.2-2.4), anxiety (OR, 2; 95% CI, 1.3-2.9), depression (OR, 1.5; 95% CI, 1.2-1.9), somatization (OR, 4.1; 95% CI, 2.7-6.0), neuroticism (OR, 3.3; 95% CI, 1.6-6.5), and clinical indicators of enteritis severity. There was a considerable level of heterogeneity among studies.
  
  
  
  In a systematic review and meta-analysis, we found >10% of patients with infectious enteritis develop IBS later; risk of IBS was 4-fold higher than in individuals who did not have infectious enteritis, although there was heterogeneity among studies analyzed. Women-particularly those with severe enteritis-are at increased risk for developing IBS, as are individuals with psychological distress and users of antibiotics during the enteritis.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota; Universidade Federal do Paraná, Curitiba, Paraná, Brazil.
authors.forename: Fabiane
authors.initials: F
authors.lastname: Klem
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Akhilesh
authors.initials: A
authors.lastname: Wadhwa
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Prokop
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Sundt
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Gianrico
authors.initials: G
authors.lastname: Farrugia
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Michael
authors.initials: M
authors.lastname: Camilleri
authors.affiliation: Division of Gastroenterology, University of California San Diego, San Diego, California.
authors.forename: Siddharth
authors.initials: S
authors.lastname: Singh
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. Electronic address: grover.madhusudan@mayo.edu.
authors.forename: Madhusudan
authors.initials: M
authors.lastname: Grover
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001007:Anxiety / Q000453:epidemiology; D001008:Anxiety Disorders / Q000453:epidemiology; D001424:Bacterial Infections / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D004751:Enteritis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005517:Foodborne Diseases / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D007411:Intestinal Diseases, Parasitic / Q000453:epidemiology; D043183:Irritable Bowel Syndrome / Q000453:epidemiology*; D008297:Male; D000075384:Neuroticism; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D013001:Somatoform Disorders / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Functional Gastrointestinal Disorders; Gastrointestinal Infections; Microbes; Post-Infectious Irritable Bowel Syndrome