Gastroenteritis, overseas travel and antibiotic use and irritable bowel syndrome (IBS) and functional dyspepsia (FD) : a population based study

The pathophysiology of IBS and FD remains unclear but a bout of gastroenteritis prior to symptoms which may have occurred during overseas travel has been associated with patients with IBS. Antibiotic use prior to the development of IBS has also been reported in patients, possibly by affecting bowel flora. We aimed to determine whether a previous bout of gastroenteritis, overseas travel and antibiotic use in the year prior to gastrointestinal symptoms is associated with people with IBS and FD from the general population. Participants (n=670) (response rate = 54%) were a random population sample from Sydney, Australia who responded to a valid survey in 1997, 2009 and the current survey in 2011 and agreed to be contacted for future research. IBS and FD were defined using Rome III criteria. Controls did not meet criteria for IBS or FD. We asked about the sudden onset of stomach and bowel problems, a bout of gastroenteritis and travel overseas in the year before stomach and bowel problems first started. Antibiotic use in the three months before stomach and bowel problems first started was also assessed. We found individuals with IBS alone (n=78) and those with IBS and/or FD (n=55), were more likely than controls (n=592) to report a sudden onset of symptoms whereas this was not the case for FD alone (n=35). Similarly, IBS alone and IBS  FD were more likely to report gastroenteritis preceding their onset of symptoms whereas this was not true of FD. Neither overseas travel nor antibiotic use were reported to a statistically significant extent preceding onset of symptoms in either IBS or FD although there was a trend to elevated antibiotic use among those with overlapping IBS and FD. Our population based data are consistent with patient studies that indicate that there is a subgroup of about one fifth of people with IBS who have post infectious IBS with the onset of symptoms associated with a prior bout of acute gastroenteritis, although onset of stomach and bowel disturbance only followed gastroenteritis in 6% of FD patients and 8% of controls.2 page(s