Response to Both Letters

Abstract

We thank Mutsch and colleagues for pointing out and summarizing a travelers' diarrhea (TD) study that we failed to include in our recent review.1 The omission was inadvertent and the authors are familiar with the study. While the rates of irritable bowel syndrome (IBS) and post‐infectious irritable bowel syndrome (PI‐IBS) were lower in this prospective study, the differential rate was suggestive of an association between TD and incident PI‐IBS at 6 months follow‐up with an adjusted odds ratio of 3.61 (95% CI, 1.74–7.51).2 This is consistent with the effect estimate described in a systematic review of all‐setting PI‐IBS by Thabane and colleagues [odds ratio (OR) 5.18; 95% CI: 3.24–8.26].3 The heterogeneity in absolute risk of PI‐IBS among travelers experiencing TD and relative risk compared to non‐exposed controls is important to be highlighted. Mutsch and colleagues reiterate many of the factors related to study setting, populations, case definition, and surveillance methods, which differ across studies and thus likely contribute to the observed heterogeneity. However, the consistency of effect found with TD and PI‐IBS, including this …