Review Prevalence of irritable bowel syndrome and functional dyspepsia after acute gastroenteritis: systematic review and meta-analysis, 2024, Porcari

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https://gut.bmj.com/content/early/2024/06/03/gutjnl-2023-331835

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. Correspondence to Dr Gianluca Ianiro, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Roma, Italy; gianluca.ianiro@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.

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

https://twitter.com/user/status/1813905446463578533
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https://www.eurekalert.org/news-releases/1051266

NEWS RELEASE 16-JUL-2024
IBS following gastroenteritis may last 4+ years in around half of those affected

Aggressive and pro-inflammatory bacteria and COVID-19 virus possible culprits

Peer-Reviewed Publication
BMJ GROUP



Irritable bowel syndrome (IBS)---characterised by abdominal pain, bloating, and altered bowel habit—may last 4 or more years following a bout of gastroenteritis in around half of those affected, finds a pooled data analysis of the available evidence, published online in the journal Gut.

Aggressive and pro-inflammatory bacteria, such as Proteobacteria and Enterobacteriaceae, and the virus responsible for COVID-19 infection, SARS-CoV-2, are possible culprits, the findings suggest.

IBS and recurrent indigestion of unknown cause (functional dyspepsia), are disorders of the gut-brain axis. Although common worldwide, their causes remain poorly understood, note the researchers.

But a sudden bout of gastroenteritis, usually brought on by a viral infection or food poisoning, is thought to be one of the possible triggers, explain the researchers, who add that an estimated 179 million people around the globe succumb to gastroenteritis every year.

To explore this further, they trawled research databases, looking for published studies on the development of IBS or functional dyspepsia after a bout of gastroenteritis in people monitored for at least 3 months after the episode.

From a haul of 75 eligible studies, 45, involving a total of 21870 people mostly from Europe and North America, were suitable for pooled data analysis. Sixteen studies were judged to be of high quality, with the rest judged to be of fair quality.

The prevalence of IBS after a bout of gastroenteritis was 14.5%. This was based on 46 studies involving 14,446 people. And the prevalence of functional dyspepsia was nearly 13%, based on 13 studies involving 5636 people.

Compared with those who had not had gastroenteritis, those who had were more than 4 times as likely to develop IBS and 3 times as likely to develop functional dyspepsia afterwards.

There were insufficient data to pool study results for the length of time functional dyspepsia persisted after gastroenteritis, but the pooled data analysis for IBS indicated that symptoms had persisted for between 6 and 11 months in 100 out of 201 people (50%) in 5 studies, and for 1-4 years in 125 out of 239 (52%) people in 3 studies.

And symptoms lasted for more than 5 years in 187 out of 471 (40%) people in 4 studies.

The pooled data analysis pointed to certain risk factors for developing IBS after a bout of gastroenteritis, the most influential of which was a history of anxiety: this was associated with a three-fold heightened risk.

Diarrhoea lasting more than 3 weeks was associated with more than double the risk, while admission to hospital and female sex were associated with, respectively, 65% and 59% heightened risks.

Analysis of the infectious agents involved showed that viruses were implicated in nearly 11% of cases (13 studies; 3585 people), bacteria in just over 18% (20 studies; 7050 people), and parasites in 30% (2 studies of 779 people).

The highest prevalence of IBS following gastroenteritis was associated with Campylobacter infection (21%), reported by 6 studies. And the odds of developing IBS were 5 times as high after a Proteobacteria species infection and 4 times as high for infection with Enterobacteriaceae species. Those infected with SARS-CoV-2 or parasites were 5 times as likely to develop IBS.

The prevalence of functional dyspepsia following gastroenteritis was nearly 14% for bacterial infections (4 studies; 759 people) and 10% for SARS-CoV-2 infection (5 studies; 1269 people), with Enterobacteriaceae species, the most common source of infection.

Although theirs is the largest pooled data analysis to date of the prevalence of IBS and functional dyspepsia after a bout of gastroenteritis, the researchers acknowledge various limitations to their findings.

The study design, definitions used, participant numbers and length of follow-up varied considerably among the included studies. And most of the studies focused on Western populations, with limited data from the Asia-Pacific region and Africa. And there was no microbiological evidence of gastroenteritis in several of the studies.

But the researchers point out: “The pathophysiology of [disorders of gut-brain interaction] is poorly understood, and these disorders are traditionally perceived by healthcare professionals as being mostly psychological and less ‘valid’ diseases, with a potential risk of underestimating patients’ expectations and complaints.”

And they conclude: “Generally, as acute gastroenteritis is a common disorder worldwide, our findings may be relevant for public health, and physicians should pay heed if their patients present with a recent episode of infectious gastroenteritis.”

JOURNAL
Gut

DOI
10.1136/gutjnl-2023-331835

METHOD OF RESEARCH
Systematic review

SUBJECT OF RESEARCH
People

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

ARTICLE PUBLICATION DATE
16-Jul-2024

COI STATEMENT
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.

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The paper said:
Disorders of gut-brain interaction
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What is that odd sentence even there? This has zero to do with the brain. It looks like of a statement of allegiance, put there because it's expected to. Like "Under his eye" and "This is the way". Actually more like "The brain works in mysterious ways", a single change of word that doesn't alter the intent and purpose of the whole phrase.

It's just there because it's imagined to be "functional", and therefore it has to, somehow, relate to the brain in some way. Not for any actual reason other than they don't know how it works, and so have to involve the usual mantra. It was said to be caused by some imaginary ghost in the mind, and so it has to be repeated lest people who believe in it be offended. What a giant dumpster fire.

This is a study following gastroenteritis. Where in the hell does some imaginary role of the mind, because let's be honest this is not about the biological organ that is the brain, rather it's about this separate magical mind-body whatever, come into play here? This profession is slowly losing its grip on reality. Big lies are basically statements of allegiance everywhere, it's following the general trend where technology may be progressing at a rapid pace, but everything else is following a rapid de-enlightenment phase. At this rate we'll be Morloks with time machines within a generation.

Here it's basically admitted plainly that it's all sophistry:
indigestion of unknown cause (functional dyspepsia), are disorders of the gut-brain axis
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"We don't know" = functional = mind-body whatever. There is no pretense of being serious here, it's just mindless dogma.
The pooled data analysis pointed to certain risk factors for developing IBS after a bout of gastroenteritis, the most influential of which was a history of anxiety: this was associated with a three-fold heightened risk.
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The highest prevalence of IBS following gastroenteritis was associated with Campylobacter infection (21%), reported by 6 studies. And the odds of developing IBS were 5 times as high after a Proteobacteria species infection and 4 times as high for infection with Enterobacteriaceae species. Those infected with SARS-CoV-2 or parasites were 5 times as likely to develop IBS.
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By my count 5 and 4 are larger than 3, and yet despite being a mere weak, extremely grasping-at-straws, association based entirely on asking overlapping questions, the most influential of those is said to be the 3, not the 5 or 4. Because belief and tradition compel. Must not offend the old mythology.

Overlapping questions yield overlapping answers, as is tradition. It doesn't bother anyone that there is no valid test for anxiety, and it typically involves overlapping questions. Whereas something like this would usually be dismissed as noise, it's infinitely believed because the belief system compels it.
But the researchers point out: “The pathophysiology of [disorders of gut-brain interaction] is poorly understood, and these disorders are traditionally perceived by healthcare professionals as being mostly psychological and less ‘valid’ diseases, with a potential risk of underestimating patients’ expectations and complaints.”
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And we keep hearing from psychosomatic ideologues how we, WE, are minimizing the burden of mental health when it's commonly acknowledged that MDs don't even take it seriously most of the time, have no issue with dismissing illnesses based on nothing but feelings that it could possibly be psychological.
 
So if they are saying gastroenteritis is implicated why are they still referring to it as functional dyspepsia. Are they naive to the doublespeak or complicit in using it. Or perhaps they’re implying it’s not “functional” but not brave enough to make it explicit. Splinters in the backside from sitting on the fence.
 
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