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East meets West: infection, nerves, and mast cells in the irritable bowel syndrome
  1. S M Collins1,
  2. G Barbara2
  1. 1Intestinal Diseases Research Program, Division of Gastroenterology, McMaster University Medical Centre, Hamilton, Ontario, Canada
  2. 2Department of Internal Medicine and Gastroenterology, University of Bologna, Italy
  1. Correspondence to:
    Professor S M Collins
    Room 4W8, HSC, McMaster University Medical Centre, Hamilton, Ontario L8N 3Z5, Canada;

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The incidence of irritable bowel syndrome following acute gastroenteritis in China is similar to that reported in the UK and North America

The irritable bowel syndrome (IBS) is the most common gastroenterological disorder seen in Western societies where it imposes a major socioeconomic burden.1 The economic impact of IBS arises, at least in part, from difficulties in diagnosis and treatment, which in turn reflect our limited conceptualisation of this disorder. Recent studies have identified acute bacterial gastroenteritis as a strong risk factor for the development of IBS2 but evidence supporting this relationship is limited to studies performed in Western countries.3–7

Although IBS has received less attention in non-Western countries, available data suggest that it is common in the African continent,8–10 Malaysia,11 and China12 where the condition is significantly underdiagnosed by Western practitioners.13 This hesitation in diagnosing IBS in Eastern countries likely reflects uncertainty regarding the influence of culture and endemic infection on the clinical expression of IBS in these countries. Indeed, in countries where enteric parasitic infestation is common, there is controversy regarding the role of infection in the development of IBS, as eradication of the parasite may not improve IBS symptoms.14 However, studies in animal models suggest that the host response to the initial infection is a critical determinant of persistent gut dysfunction, and the continued presence of the parasite is not necessary for induction of a chronic dysfunctional …

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