Original article
Postinfectious Irritable Bowel Syndrome After a Food-Borne Outbreak of Acute Gastroenteritis Attributed to a Viral Pathogen

https://doi.org/10.1016/j.cgh.2006.11.025Get rights and content

Background & Aims: A large outbreak of acute gastroenteritis at the annual meeting of the Canadian Society of Gastroenterology Nurses and Associates (CSGNA) was attributed to food-borne norovirus. A prospective study was undertaken to determine the incidence and natural history of postinfectious irritable bowel syndrome (PI-IBS). Methods: Questionnaires addressing demographics, medical history, acute illness, prior bowel function, and current symptoms were mailed to all delegates within 1 month of the outbreak. Follow-up questionnaires were mailed at 3, 6, 12, and 24 months. The prevalence of new Rome I IBS among participants with and without acute enteric illness during the outbreak was calculated for each time point. Risk factors were assessed by multiple logistic regression. Results: Baseline surveys were returned by 139 of 197 delegates (70.6%; mean age, 48 ± 6 years; 95.0% female), of whom 135 (97.1%), 133 (95.7%), 128 (92.1%), and 116 (83.4%) returned the 3-, 6-, 12-, and 24-month surveys, respectively. One hundred seven respondents (76.9%) reported an acute enteric illness during the outbreak. Eighteen subjects reported premorbid IBS. Among the remainder, 21 of 89 who experienced gastroenteritis (23.6%) reported symptoms consistent with PI-IBS at 3 months versus 1 of 29 (3.4%) who remained well (odds ratio, 6.9; 95% confidence interval, 1.0–48.7; P = .014). At 6, 12, and 24 months, the prevalence of IBS was similar among exposed versus nonexposed individuals. In multiple logistic regression, vomiting during the acute illness independently predicted risk of PI-IBS at 3 months (odds ratio, 10.5; 95% confidence interval, 1.3–85.5; P = .028). Conclusions: PI-IBS is common after presumptive viral gastroenteritis but might be more transient than after bacterial dysentery.

Section snippets

Materials and Methods

The CSGNA Annual Meeting took place in September 2002, with 202 registered delegates. Immediately after the outbreak, local public health authorities initiated a comprehensive investigation that included standardized interviews, inspection of kitchen and dining facilities, and full review of menus and ingredients. No pathogen was identified among the 17 delegates who submitted stool samples. However, a Norwalk-like virus was implicated by the public health investigation on the basis of the

Survey Response

Surveys were mailed to the 197 of 202 conference participants for whom contact information was available. Response rates are summarized in Table 1.

Baseline Characteristics

Respondents were predominantly female (132 of 139, 95.0%), with mean age of 48 ± 6 years. Eighteen respondents (12.9%) reported a premorbid bowel habit consistent with IBS by Rome I criteria and were excluded from the cohort considered at risk of PI-IBS. Among the remaining 121 subjects, 91 (75.2%) reported an acute enteric illness during or

Discussion

These results support the overwhelming evidence that exposure to infectious gastroenteritis leads to new IBS symptoms in some individuals.2, 3, 4, 5, 6, 7, 8, 9, 10 However, this study assesses PI-IBS after acute viral gastroenteritis and is among very few to follow participants for more than 1 year. It also follows symptoms in a cohort of health care professionals, whose compliance is high and whose symptom reporting might be considered more reliable than that of the general population.

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    Supported by a Hamilton Health Sciences Research Development Award.

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