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Mind over matter in the postinfective irritable bowel
  1. D A DROSSMAN
  1. UNC Functional GI Disorders Centre
  2. Division of Digestive Diseases,
  3. 726 Burnett-Womack Bldg. CB 7080,
  4. University of North Carolina,
  5. Chapel Hill, N.C. 27599–7080, USA

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See article on page 400

In recent years, our understanding of the irritable bowel syndrome (IBS) has evolved from being considered solely a disorder of motility, to one that is characterised by dysregulation of brain–gut function, manifest by gut motor hyper-reactivity and enhanced visceral sensitivity to various stresses.1 In this regard, several psychosocial factors, namely life stress, abuse, psychological co-morbidity, and illness behaviour, have been implicated in the clinical expression of IBS.2 However, although most published studies have shown an associationof psychosocial factors with IBS, only one study until now, has reported that psychosocial distress in patients with acute infectious diarrhoea predicted the later development of IBS symptoms.3 In a follow up study in this issue, Gweeet al (see page 400) elaborate upon this observation by describing the psychosocial, physiological and histopathological features of individuals who develop postinfectious IBS symptoms.

In a sample of 94 patients with acute gastroenteritis studied in an infectious disease unit, 22 (23%) were found three months later to fulfil Rome criteria for IBS.4 When comparing this group of symptomatic patients (IBS+) to the remaining sample (77%) who resolved their gut symptoms (IBS−), three major findings were noted. (1) Psychosocial difficulties were again shown to influence who with acute gastroenteritis would remain symptomatic. Specifically, in a regression analysis, pre-existent life stress and hypochondriasis were the strongest predictors of the IBS+ group, and the development of IBS-like symptoms was not explained by illness behaviours. (2) Acute gastroenteritis was associated with …

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