Original article
Gastrointestinal Symptoms After Infectious Diarrhea: A Five-Year Follow-Up in a Swedish Cohort of Adults

https://doi.org/10.1016/j.cgh.2007.01.007Get rights and content

Background & Aims: Gastrointestinal infection is a well-recognized trigger for functional bowel disorder. This study evaluated gastrointestinal symptoms and risk factors for their development after diarrheal disease of proven or strongly suspected infectious etiology in adults. Methods: The cohort of patients was derived from a previous study that determined the rate at which enteropathogens could be isolated at the time of diarrheal disease in adults. After 5 years, 717 of 851 patients were accessible for a questionnaire asking for persistence of gastrointestinal symptoms. Results: Of 508 returned questionnaires, 333 were from patients with no previous gastrointestinal complaints. Forty-one (12%) of them had gastrointestinal symptoms for 3 months or more after the infectious diarrhea, and 31 (9%) still had symptoms at the end of the follow-up period. Irritable bowel syndrome was most common (68%), but other functional bowel disorder diagnoses were found in all but one of the others. Female gender (odds ratio, 2.65, 95% confidence interval, 1.28–5.50) and use of antibiotic treatment (odds ratio, 2.37; 95% confidence interval, 1.07–5.25) were risk factors for development of postinfectious functional bowel disorder. No increase in risk was associated with the type of enteropathogen causing diarrhea. Conclusions: Infectious diarrhea in previously healthy adults carried a substantial risk of triggering postinfectious functional bowel disorder. Irritable bowel syndrome was the most common, but other functional bowel disorders were also found. We did not find any new clinical tools that would facilitate the prediction of long-standing symptoms.

Section snippets

Materials and Methods

All the 851 patients from the original study8 were included in the present study of sufferers from a diarrheal disease of proven or strongly suspected infectious etiology (infectious diarrhea). Of these, 134 persons could not be reached for the following reasons: 107 had died, 14 had a non-traceable social security number, and 13 had no known address or a protected identity. At the end of 2002, the remaining 717 persons were sent a questionnaire to fill in and return by mail. The questionnaire

Results

A total of 508 patients (71%) returned the study questionnaire. Of these, 173 were excluded because of pre-existing symptoms compatible with FBD or other GI diseases, and 2 were in a physical condition that prevented them from answering the questionnaire. This meant that 333 previously healthy patients, denying any GI problems before the infectious diarrhea, formed the study population. Forty-one (12%) patients had developed persistent (3 months or longer) GI symptoms, and 31 (9%) patients

Discussion

Our study adds some new aspects to the available information regarding the development and long-term persistence of GI symptoms after an infectious diarrhea in previously healthy adults. Five years later, we found that 12% had had symptoms with a sufficient duration to qualify for a diagnosis of an FBD. From a prognostic viewpoint, 24% recovered to normal bowel habits during the study period, which is slightly worse than what has been reported in a long-term study by Neal et al.2 Female gender

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