Division of Epidemiology and Prevention of Communicable Diseases and World Health Organization Collaborating Centre for Travellers' Health, Institute of Social and Preventive Medicine, University of Zurich, Hirschengraben 84, Zurich, Switzerland.
J Travel Med. 2011 Jul-Aug;18(4):250-6. doi: 10.1111/j.1708-8305.2011.00529.x. Epub 2011 Jun 15.
Travelers' diarrhea (TD) remains a frequent travel-associated infection. Between 4 and 32% of enteric infections were followed by a postinfectious irritable bowel syndrome (pIBS) with long-term sequelae in various settings. Travel-related IBS incidence rates are based on small studies and IBS predictors have not been sufficiently evaluated.
Adult travelers to resource-limited destinations participated in a prospective questionnaire-based cohort study. Demographics, travel characteristics, and medical history were assessed and those with functional or organic gastrointestinal disorders were excluded. Immediately after return from abroad, the volunteers completed a second questionnaire on TD, other health impairments, and on nutritional hygiene. Six-months post-travel, a follow-up questionnaire assessed IBS based on Rome III criteria. Risk factors were analyzed by multiple logistic regression.
Among a total of 2,476 subjects analyzed (participation rate 72.4%), 38 (1.5%) developed new IBS, and the 6-month incidence rate for pIBS was 3.0% (95% CI 1.9-4.2) following TD. Significant risk factors were TD during the surveyed journey (OR 3.7; 95% 1.8-7.4), an adverse life event experienced within 12 months pre-travel (OR 3.1; 1.4-6.8), and a diarrheal episode experienced within 4 months pre-travel (OR 2.7; 95% CI 1.3-5.6). Following multiple diarrheal episodes, the risk of acquiring IBS increased by six times.
In a large population of European travelers IBS had a lower incidence rate as compared to previous studies. Particular risk groups were identified; those may need to be protected.
旅行者腹泻（TD）仍然是一种常见的旅行相关感染。在各种环境下，4%至 32%的肠内感染后会出现感染后肠易激综合征（pIBS），并伴有长期后遗症。与旅行相关的 IBS 发病率基于小型研究，并且尚未充分评估 IBS 的预测因素。
前往资源有限目的地的成年旅行者参加了一项前瞻性基于问卷的队列研究。评估了人口统计学、旅行特征和病史，并排除了有功能性或器质性胃肠道疾病的患者。从国外返回后，志愿者立即完成了关于 TD、其他健康损害和营养卫生的第二份问卷。旅行后 6 个月，通过罗马 III 标准评估了 IBS 的随访问卷。通过多因素逻辑回归分析了危险因素。
在总共分析的 2476 名受试者中（参与率为 72.4%），有 38 名（1.5%）新发 IBS，TD 后 6 个月的 pIBS 发病率为 3.0%（95%CI 1.9-4.2）。显著的危险因素是旅行期间的 TD（OR 3.7；95%CI 1.8-7.4）、旅行前 12 个月内经历的不良生活事件（OR 3.1；95%CI 1.4-6.8）和旅行前 4 个月内发生的腹泻发作（OR 2.7；95%CI 1.3-5.6）。发生多次腹泻发作后，患 IBS 的风险增加了六倍。
在欧洲旅行者的大型人群中，IBS 的发病率低于以往的研究。确定了特定的风险群体；这些人可能需要受到保护。
