Eight year prognosis of postinfectious irritable bowel syndrome following waterborne bacterial dysentery
- John K Marshall1,
- Marroon Thabane1,
- Amit X Garg2,
- William F Clark2,
- Paul Moayyedi1,
- Stephen M Collins1,
- Walkerton Health Study Investigators
- 1Department of Medicine (Division of Gastroenterology) and Farncombe Family Digestive Health Research Institute,McMaster University, Hamilton, Ontario, Canada
- 2Department of Medicine (Division of Nephrology), University of Western Ontario, London, Ontario, Canada
- Correspondence to Dr John K Marshall, Division of Gastroenterology (2F59), McMaster University Medical Centre, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada;
Contributors Study concept and design (JKM, MT, AXG, WFC, SMC); acquisition of data (JKM, MT, AXG, WFC); analysis and interpretation of data (JKM, MT, AXG, PM, SMC); drafting of the manuscript (JKM, MT); critical revision of the manuscript for important intellectual content (JKM, MT, AXG, WFC, PM, SMC); statistical analysis (MT); obtaining funding (JKM, MT, PM, SMC); study supervision (JKM, SMC).
- Received 2 November 2009
- Accepted 24 December 2009
Background Although postinfectious irritable bowel syndrome (PI-IBS) is a well-recognised complication of acute gastroenteritis, its prognosis remains poorly defined. The natural history of PI-IBS was assessed among participants in the Walkerton Health Study (WHS), which has followed the long-term effects of a large outbreak of acute gastroenteritis related to municipal water contamination in May 2000.
Methods WHS participants were invited to return for annual assessment at a research clinic. Adult residents of Walkerton at the time of the outbreak who enrolled in 2002/2003 and returned for assessment in 2008 were eligible for a PI-IBS study cohort if they had no prior history of IBS or inflammatory bowel disease. A modified Bowel Disease Questionnaire was used to diagnose IBS by Rome I criteria and to identify IBS subtypes.
Results Of 4561 WHS participants, 2451 returned for their 8 year assessment and 1166 were eligible for the PI-IBS study cohort (688 females, mean age 46.2 years). The prevalence of IBS among 742 eligible subjects who suffered acute gastroenteritis during the outbreak declined from 28.3% after 2–3 years to 15.4% after 8 years, but remained significantly increased compared with controls who did not have acute gastroenteritis (OR 3.12; 95% CI 1.99 to 5.04). Independent risk factors for PI-IBS at 8 years included female gender, younger age, prior anxiety/depression, and fever or weight loss during the acute enteric illness. IBS subtypes were not stable over time.
Conclusions Acute gastroenteritis can trigger IBS symptoms that persist for at least 8 years. Characteristics of the host and the acute enteric illness can predict the long-term risk of PI-IBS.
Walkerton Health Study Investigators: William Clark, Stephen M. Collins, Amit Garg, R. Brian Haynes, John Howard, Jennifer MacNab, Jeff Mahon, John K. Marshall, Douglas Matsell, Louise Moist, Janet Pope, Joel Ray, Patricia Rosas-Arellano, Marina Salvadori, Rita Suri.
Funding Ontario Ministry of Health and Long-Term Care and the Crohn's and Colitis Foundation of Canada (CCFC).
Competing interests None.
Ethics approval The study protocol received full approval from both the Hamilton Health Sciences/McMaster University Research Ethics Board (Hamilton, Ontario) and the University of Western Ontario's Office of Research Ethics (London, Ontario).
Provenance and peer review Not commissioned; externally peer reviewed.