Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Enteric NeuroScience Program, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
Gastroenterology. 2019 Jan;156(1):46-58.e7. doi: 10.1053/j.gastro.2018.07.011. Epub 2018 Nov 28.
BACKGROUND & AIMS: The existence of postinfection irritable bowel syndrome (PI-IBS) has been substantiated by epidemiology studies conducted in diverse geographic and clinical settings. However, the available evidence has not been well summarized, and there is little guidance for diagnosis and treatment of PI-IBS. The ROME Foundation has produced a working team report to summarize the available evidence on the pathophysiology of PI-IBS and provide guidance for diagnosis and treatment, based on findings reported in the literature and clinical experience.
The working team conducted an evidence-based review of publication databases for articles describing the clinical features (diagnosis), pathophysiology (intestinal sensorimotor function, microbiota, immune dysregulation, barrier dysfunction, enteroendocrine pathways, and genetics), and animal models of PI-IBS. We used a Delphi-based consensus system to create guidelines for management of PI-IBS and a developed treatment algorithm based on published findings and experiences of team members.
PI-IBS develops in about 10% of patients with infectious enteritis. Risk factors include female sex, younger age, psychological distress during or before acute gastroenteritis, and severity of the acute episode. The pathogenesis of PI-PBS appears to involve changes in the intestinal microbiome as well as epithelial, serotonergic, and immune system factors. However, these mechanisms are incompletely understood. There are no evidence-based, effective pharmacologic strategies for treatment of PI-IBS. We provide a consensus-based treatment algorithm, based on clinical presentation and potential disease mechanisms.
Based on a systematic review of the literature and team experience, we summarize the clinical features, pathophysiology (from animal models and human studies), and progression of PI-IBS. Based on these findings, we present an algorithm for diagnosis and treatment of PI-IBS based on team consensus. We also propose areas for future investigation.
在不同地理和临床环境中进行的流行病学研究证实了感染后肠易激综合征（PI-IBS）的存在。然而，现有的证据尚未得到很好的总结，PI-IBS 的诊断和治疗也缺乏指导。ROME 基金会已经制作了一份工作组报告，根据文献报道和临床经验中的发现，总结了 PI-IBS 的病理生理学现有证据，并为诊断和治疗提供指导。
工作组对描述 PI-IBS 临床特征（诊断）、病理生理学（肠道感觉运动功能、微生物群、免疫失调、屏障功能障碍、肠内分泌途径和遗传学）以及 PI-IBS 动物模型的文献数据库进行了循证审查。我们使用基于德尔菲的共识系统为 PI-IBS 的管理制定指南，并根据已发表的发现和工作组成员的经验制定治疗算法。
约 10%的传染性肠炎患者会发展为 PI-IBS。危险因素包括女性、年龄较小、急性肠胃炎期间或之前心理困扰以及急性发作的严重程度。PI-PBS 的发病机制似乎涉及肠道微生物组以及上皮、5-羟色胺能和免疫系统因素的变化。然而，这些机制尚未完全理解。目前尚无针对 PI-IBS 的基于证据的有效药物治疗策略。我们根据临床表现和潜在疾病机制提供了一种基于共识的治疗算法。
根据文献综述和工作组经验，我们总结了 PI-IBS 的临床特征、病理生理学（来自动物模型和人体研究）和进展。基于这些发现，我们提出了一种基于团队共识的 PI-IBS 诊断和治疗算法。我们还提出了未来研究的领域。
