Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
J Gastroenterol Hepatol. 2011 Apr;26 Suppl 3:94-101. doi: 10.1111/j.1440-1746.2011.06643.x.
Irritable bowel syndrome (IBS), once thought to be a psychosomatic disease, is being considered to be more organic. Post-infectious IBS (PI-IBS), defined as acute onset IBS (by Rome criteria) after gastrointestinal infection in an individual without prior IBS with two or more of the followings: fever, vomiting, diarrhea, a positive stool culture. The recent and old literature of PI-IBS will be reviewed. Future directions for research will be presented.
Literature on PI-IBS was reviewed by electronic search and cross references of these papers.
Interest in studies on PI-IBS, which was described five to six decades ago, re-surfaced recently. 3.6 to 32% patients with acute gastroenteritis develop PI-IBS during 3-12 month follow-up. PI-IBS is commonly diarrhea predominant. Factors implicated in development include nature of pathogens, duration and severity of diarrhea, younger age, female gender and psychological co-morbidities like anxiety and depression. The pathogenesis of PI-IBS is largely related to continuing gut inflammation due to inability of the host to contain the inflammatory reaction, altered gut microbiota, increased intestinal permeability, muscle hyper-contractility and visceral hypersensitivity. There could be an overlap between PI-IBS and post-infectious malabsorption syndrome (PI-MAS), popularly known as tropical sprue.
Development of IBS in a subset of patients with acute gastroenteritis is uncontested. This is expected to open a paradigm shift in understanding the pathogenesis of IBS. Future studies should address the issue of overlap of PI-IBS and PI-MAS. Exploring the molecular mechanisms of pathogenesis of PI-IBS may help to design preventive and therapeutic strategies.
肠易激综合征（IBS）曾被认为是一种心身疾病，但现在被认为更具器质性。感染后肠易激综合征（PI-IBS）被定义为在没有先前肠易激综合征病史的个体中，胃肠道感染后急性发作的肠易激综合征（根据罗马标准），并伴有以下两种或两种以上情况：发热、呕吐、腹泻、粪便培养阳性。本文将对近期和以往关于 PI-IBS 的文献进行综述，并提出未来的研究方向。
通过电子搜索和这些论文的交叉引用，对 PI-IBS 的文献进行了回顾。
PI-IBS 的研究兴趣在五六十年前就已经出现，最近又重新出现。在 3-12 个月的随访中，有 3.6%至 32%的急性胃肠炎患者会发展为 PI-IBS。PI-IBS 通常以腹泻为主。发病的相关因素包括病原体的性质、腹泻的持续时间和严重程度、年龄较小、女性以及焦虑和抑郁等心理合并症。PI-IBS 的发病机制主要与宿主无法控制炎症反应、肠道微生物群改变、肠道通透性增加、肌肉过度收缩和内脏敏感性增加导致的持续肠道炎症有关。PI-IBS 与感染后吸收不良综合征（PI-MAS，俗称热带口炎性腹泻）之间可能存在重叠。
急性胃肠炎患者中有一部分会发展为 IBS，这一事实毋庸置疑。这有望开启对 IBS 发病机制的理解的范式转变。未来的研究应该解决 PI-IBS 和 PI-MAS 重叠的问题。探索 PI-IBS 的发病机制的分子机制可能有助于设计预防和治疗策略。
