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  • Prevalence of irritable bowel syndrome and functional dyspepsia after acute gastroenteritis: systematic review and meta-analysis

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Neurogastroenterology
Original research
Prevalence of irritable bowel syndrome and functional dyspepsia after acute gastroenteritis: systematic review and meta-analysis
  1. Serena Porcari1,2,3,
  2. Maria Rosa Ingrosso1,2,3,
  3. Marcello Maida4,
  4. Leonardo Henry Eusebi5,
  5. Christopher Black6,
  6. Antonio Gasbarrini1,2,3,
  7. Giovanni Cammarota1,2,3,
  8. Alexander Charles Ford6,7,
  9. Gianluca Ianiro1,2,3
  1. 1 Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Roma, Italy
  2. 2 Department of Medical and Surgical Sciences, UOC Gastroenterologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
  3. 3 Department of Medical and Surgical Sciences, UOC CEMAD Centro Malattie dell'Apparato Digerente, Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario Gemelli IRCCS, Roma, Italy
  4. 4 Department of Medicine and Surgery, University of Enna ‘Kore’, Enna, Italy
  5. 5 Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
  6. 6 Leeds Teaching Hospitals NHS Trust, Leeds, UK
  7. 7 University of Leeds, Leeds, UK
  1. Correspondence to Dr Gianluca Ianiro, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Roma, Italy; gianluca.ianiro{at}unicatt.it

Abstract

Objective Disorders of gut-brain interaction may arise after acute gastroenteritis. Data on the influence of pathogen type on the risk of postinfection IBS (PI-IBS), as on postinfection functional dyspepsia (PI-FD), are limited. We conducted a systematic review and meta-analysis to determine prevalence of PI-IBS or PI-FD after acute gastroenteritis.

Design We included observational studies recruiting ≥50 adults and reporting prevalence of IBS or FD after acute gastroenteritis with ≥3-month follow-up. A random effects model was used to estimate prevalence and ORs with 95% CIs.

Results In total, 47 studies (28 170 subjects) were eligible. Overall prevalence of PI-IBS and PI-FD were 14.5% and 12.7%, respectively. IBS persisted in 39.8% of subjects in the long-term (>5 years follow-up) after diagnosis. Individuals experiencing acute gastroenteritis had a significantly higher odds of IBS (OR 4.3) and FD (OR 3.0) than non-exposed controls. PI-IBS was most associated with parasites (prevalence 30.1%), but in only two studies, followed by bacteria (18.3%) and viruses (10.7%). In available studies, Campylobacter was associated with the highest PI-IBS prevalence (20.7%) whereas Proteobacteria and SARS-CoV-2 yielded the highest odds for PI-IBS (both OR 5.4). Prevalence of PI-FD was 10.0% for SARS-CoV-2 and 13.6% for bacteria (Enterobacteriaceae 19.4%).

Conclusion In a large systematic review and meta-analysis, 14.5% of individuals experiencing acute gastroenteritis developed PI-IBS and 12.7% PI-FD, with greater than fourfold increased odds for IBS and threefold for FD. Proinflammatory microbes, including Proteobacteria and subcategories, and SARS-CoV-2, may be associated with the development of PI-IBS and PI-FD.

  • intestinal microbiology
  • infectious diarrhoea
  • infective colitis
  • irritable bowel syndrome
  • functional dyspepsia

Data availability statement

Data are available on reasonable request.

https://doi.org/10.1136/gutjnl-2023-331835

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    Data availability statement

    Data are available on reasonable request.

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    Footnotes

    • SP and MRI are joint first authors.

    • ACF and GI are joint senior authors.

    • X @DrCJBlack, @GiovanniCammar9, @gianluca1aniro

    • Contributors GI is the guarantor of the article. SP and GI conceived the study. SP, GI and ACF designed the study. SP and MRI performed the systematic search of eligible studies and extracted related data. MM and LHE performed the quality assessment. SP, MRI, ACF and GI analysed and interpreted the data. SP, MRI, ACF and GI wrote the initial draft of the manuscript. All authors provided critical revision of the manuscript and approved its final version for submission.

    • Funding The staff of the Fondazione Policlinico Gemelli IRCCS thank the Fondazione Roma for the invaluable support to their scientific research. This work was supported by the Ricerca Finalizzata Giovani Ricercatori 2018 of the Italian Ministry of Health (project GR-2018-12365734) and by the Fondo Italiano per la Scienza 2021 of the Italian Ministry of University and Research (project FIS_00001711) to GI; by the BIOMIS grant of the Italian Ministry of Research to AG, GC and GI.

    • Disclaimer The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

    • Competing interests AG reports personal fees for consultancy for Eisai, 3PSolutions, Real Time Meeting, Fondazione Istituto Danone, Sinergie Board MRGE and Sanofi; personal fees for acting as a speaker for Takeda, AbbVie and Sandoz and personal fees for acting on advisory boards for VSL3 and Eisai. GI has received personal fees for acting as speaker for Alfa Sigma, Biocodex, Illumina, Malesci, Sofar and Tillotts Pharma, and for acting as consultant/advisor for Biocodex, Malesci and Tillots Pharma. The other authors have no potential competing interest to disclose.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.