The post-infection syndrome of the irritable bowel: recent recommendations of the Rome Foundation Working team

Abstract

The presence of such form of the irritable bowel syndrome (IBS) as a post-infection IBS (PI — IBS) was proved a long time ago in the clinical-laboratory and epidemiological investigations, conducted in various geographic and clinical conditions. However, the official clinical recommendations on the diagnosis and treatment of PI — IBS were absent for a long time. With the purpose of summarizing the existing evidence in pathophysiology, diagnosis and treatment of PI — IBS, the Rome Foundation established a post-infection IBS Working Team, that presented the report and recommendations, based on the literature search and clinical experience. The Working Team performed a thorough analysis of the database of existing literature sources describing clinical peculiarities (diagnosis), pathophysiology (intestinal sensomotor functions, intestinal microbiota, immune deregulation, barrier dysfunction, enteroendocrine pathways, genetics) and animal models of the PI — IBS. With this, to create clinical recommendation for the management of patients with PI — IBS, the Delphi consensus system was used, which is based on the evidence-based medicine and own clinical experience of the team members. There is consistent evidence indicating that PI — IBS can develop in near 10 % of patients following an episode of acute infectious gastroenteritis. The risk factors include female gender, younger age, psychological distress during or before an episode of acute infectious gastroenteritis, and the episode severity. In the PI — IBS, the following factors play an important role: changes in the intestinal microbiota, factors of the epithelial, serotonergic and immune systems, although the mechanisms of the PI — IBS development and progression per se are still not fully understood. Since specific therapeutic recommendations for PI — IBS have not been developed yet, its treatment is similar to the IBS therapy. The algorithm for the PI — IBS diagnosis and treatment has been presented, and directions for the future investigations have been proposed.