Post-Infectious Irritable Bowel Syndrome – A Review of the Literature

Zusammenfassung

Hintergrund: Trotz erheblicher Forschungen in den vergangenen Jahren sind die epidemiologischen Charakteristika des postinfektiösen Reizdarmsyndroms (PI-RDS) nicht bekannt. Die Schätzungen der Inzidenz nach gastrointestinaler Infektion zeigen erhebliche Variation und der Anteil der Patienten mit einer Infektionsgeschichte an allen RDS-Patienten ist unbekannt. Mit diesem Review versuchen wir, publizierten Schätzungen der (i) Prävalenz des PI-RDS an allen RDS-Patienten und (ii) die PI-RDS-Inzidenz nach gastrointestinaler Infektion zusammenzufassen. Methodische Unterschiede, die die Variation der publizierten Daten erklären könnten, und mögliche Risikofaktoren für ein PI-RDS werden diskutiert. Methoden: Eine systematische Literatursuche von in PUBMED indizierten Arbeiten zur Epidemiologie und Risikofaktoren des PI-RDS. Ergebnisse: Die berichtete Inzidenz des PI-RDS variiert zwischen 7 und 36 % für epidemische infektiöse Ereignisse, und zwischen 4 und 36 % für individuelle Infektionen und 4 und 14 % für die Reisediarrhö. In Abhängigkeit vom Studiendesign berichten zwischen 7 und mehr als einem Drittel aller RDS-Patienten eine infektiöse Vorgeschichte. Biomarker und Prädiktoren variieren erheblich zwischen den Studien. Schlussfolgerungen: Das PI-RDS scheint eine häufige Folge einer infektiösen Enteritis zu sein, aber genauere Schätzungen sind bislang nicht vorhanden.

Abstract

Introduction: Despite considerable research efforts, the epidemiological characteristics of post-infectious symptoms of the irritable bowel syndrome-type (PI-IBS) are not yet well defined. Estimates of its incidence after gastrointestinal (GI) infection show considerable variation and the number of patients with a history of a GI infection among all patients with IBS is practically unknown. This review aims at summarizing published estimates (i) on the prevalence of PI-IBS among all IBS patients and (ii) on PI-IBS incidence after GI infection, critically discusses methodological differences that may explain the variation of the presented findings and gives an overview on currently identified risk factors for the development of PI-IBS. Methods: A systematic literature review was perfomed of studies indexed in PUBMED that assessed the epidemiology and risk factors of PI-IBS. Results: The reported incidence of PI-IBS ranges for epidemic infections between 7 and 36 %, for individual infections between 4 and 36 % and for traveller’s diarrhea from 4 to 14 %. Estimates of the prevalence of PI-IBS range from as low as 7 % to more than ⅓ of all IBS patients, depending on the study design. The predictors and biomarkers are varying among the studies. Conclusion: PI-IBS appears to be common following infectious enteritis and among all IBS patients, but precise estimates are still lacking.

Schlüsselwörter

Colon irritabile - infektiöse Kolitis - virale Gastroenteritis - Prävalenz - inzidenz - Pathophysiologie

Key words

irritable bowel syndrome - post-infectious bacterial enteritis - viral gastroenteritis - prevalence - incidence - pathophysiology

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