Characteristics and Risk Factors of Post-Infection Irritable Bowel Syndrome After Campylobacter Enteritis

      Background & Aims

      Campylobacter is the leading cause of bacterial gastroenteritis in the United States. We investigated the prevalence of postinfection irritable bowel syndrome (PI-IBS) in a cohort with culture-confirmed Campylobacter cases; risk factors for PI-IBS based on clinical factors; and shifts in IBS patterns postinfection in patients with pre-existing IBS.


      The Minnesota Department of Health collects data on symptoms and exposures upon notification of Campylobacter cases. From 2011 through 2019, we sent surveys (the Rome III and IBS symptom severity surveys) to 3586 patients 6 to 9 months after Campylobacter infection. The prevalence of PI-IBS was estimated and risk factors were assessed using multivariable logistic regression.


      There were 1667 responders to the survey, 249 of whom had pre-existing IBS. Of the 1418 responders without pre-existing IBS, 301 (21%) subsequently developed IBS. Most of these individuals had IBS-mixed (54%), followed by IBS-diarrhea (38%), and IBS-constipation (6%). The mean IBS symptom severity score was 218 (indicating moderate severity). Female sex, younger age, bloody stools, abdominal cramps, and hospitalization during acute enteritis were associated with increased risk, whereas fever was protective for the development of PI-IBS. Antibiotic use and exposure patterns were similar between PI-IBS and control groups. Among patients with IBS-mixed or IBS-diarrhea before infection, 78% retained their subtypes after infection. In contrast, only 50% of patients with IBS-constipation retained that subtype after infection, whereas 40% transitioned to IBS-mixed. Of patients with pre-existing IBS, 38% had increased frequency of abdominal pain after Campylobacter infection.


      In a cohort of patients with Campylobacter infection in Minnesota, 21% developed PI-IBS; most cases reported mixed IBS or diarrhea of moderate severity. Demographic and clinical factors during acute enterocolitis are associated with PI-IBS development. Campylobacter infection also can result in a switch of a pre-existing IBS phenotype.

      Graphical abstract


      Abbreviations used in this paper:

      GI (gastrointestinal), IBS (irritable bowel syndrome), IBS-C (constipation-predominant IBS), IBS-D (diarrhea-predominant IBS), IBS-M (mixed IBS), IBS-SSS (Irritable Bowel Syndrome Symptom Severity Scale), MDH (Minnesota Department of Health), OR (odds ratio), PI-IBS (postinfection irritable bowel syndrome)
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        • Lovell R.M.
        • Ford A.C.
        Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis.
        Clin Gastroenterol Hepatol. 2012; 10: 712-721 e4
        • Enck P.
        • Aziz Q.
        • Barbara G.
        • et al.
        Irritable bowel syndrome.
        Nat Rev Dis Primers. 2016; 2: 16014
        • Klem F.
        • Wadhwa A.
        • Prokop L.J.
        • et al.
        Prevalence, risk factors, and outcomes of irritable bowel syndrome after infectious enteritis: a systematic review and meta-analysis.
        Gastroenterology. 2017; 152: 1042-1054 e1
        • Scallan Walter E.J.
        • Crim S.M.
        • Bruce B.B.
        • et al.
        Postinfectious irritable bowel syndrome after Campylobacter infection.
        Am J Gastroenterol. 2019; 114: 1649-1656
        • Hanevik K.
        • Dizdar V.
        • Langeland N.
        • et al.
        Development of functional gastrointestinal disorders after Giardia lamblia infection.
        BMC Gastroenterol. 2009; 9: 27
        • Wensaas K.A.
        • Langeland N.
        • Hanevik K.
        • et al.
        Irritable bowel syndrome and chronic fatigue 3 years after acute giardiasis: historic cohort study.
        Gut. 2012; 61: 214-219
        • Zanini B.
        • Ricci C.
        • Bandera F.
        • et al.
        Incidence of post-infectious irritable bowel syndrome and functional intestinal disorders following a water-borne viral gastroenteritis outbreak.
        Am J Gastroenterol. 2012; 107: 891-899
        • Barbara G.
        • Grover M.
        • Bercik P.
        • et al.
        Rome Foundation Working Team report on post-infection irritable bowel syndrome.
        Gastroenterology. 2019; 156: 46-58 e7
        • Dunlop S.P.
        • Jenkins D.
        • Neal K.R.
        • et al.
        Relative importance of enterochromaffin cell hyperplasia, anxiety, and depression in postinfectious IBS.
        Gastroenterology. 2003; 125: 1651-1659
        • Shah E.D.
        • Riddle M.S.
        • Chang C.
        • et al.
        Estimating the contribution of acute gastroenteritis to the overall prevalence of irritable bowel syndrome.
        J Neurogastroenterol Motil. 2012; 18: 200-204
        • Scallan E.
        • Hoekstra R.M.
        • Angulo F.J.
        • et al.
        Foodborne illness acquired in the United States--major pathogens.
        Emerg Infect Dis. 2011; 17: 7-15
        • Tack D.M.
        • Marder E.P.
        • Griffin P.M.
        • et al.
        Preliminary incidence and trends of infections with pathogens transmitted commonly through food - Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 2015-2018.
        MMWR Morb Mortal Wkly Rep. 2019; 68: 369-373
        • Marshall J.K.
        • Thabane M.
        • Garg A.X.
        • et al.
        Incidence and epidemiology of irritable bowel syndrome after a large waterborne outbreak of bacterial dysentery.
        Gastroenterology. 2006; 131 (quiz 660): 445-450
        • Thabane M.
        • Simunovic M.
        • Akhtar-Danesh N.
        • et al.
        Development and validation of a risk score for post-infectious irritable bowel syndrome.
        Am J Gastroenterol. 2009; 104: 2267-2274
        • Dewey-Mattia D.
        • Manikonda K.
        • Hall A.J.
        • et al.
        Surveillance for foodborne disease outbreaks - United States, 2009-2015.
        MMWR Surveill Summ. 2018; 67: 1-11
        • Longstreth G.F.
        • Thompson W.G.
        • Chey W.D.
        • et al.
        Functional bowel disorders.
        Gastroenterology. 2006; 130: 1480-1491
        • Francis C.Y.
        • Morris J.
        • Whorwell P.J.
        The irritable bowel severity scoring system: a simple method of monitoring irritable bowel syndrome and its progress.
        Aliment Pharmacol Ther. 1997; 11: 395-402
        • Ibeakanma C.
        • Ochoa-Cortes F.
        • Miranda-Morales M.
        • et al.
        Brain-gut interactions increase peripheral nociceptive signaling in mice with postinfectious irritable bowel syndrome.
        Gastroenterology. 2011; 141: 2098-2108 e5
        • Bettes N.
        • Griffith J.
        • Camilleri M.
        • et al.
        Su2070 risk and predictors of post-infectious irritable bowel syndrome among community-acquired cases of bacterial enteritis.
        Gastroenterology. 2014; 146 (S-538)
        • Man S.M.
        The clinical importance of emerging Campylobacter species.
        Nat Rev Gastroenterol Hepatol. 2011; 8: 669-685
        • Polster A.V.
        • Palsson O.S.
        • Tornblom H.
        • et al.
        Subgroups of IBS patients are characterized by specific, reproducible profiles of GI and non-GI symptoms and report differences in healthcare utilization: a population-based study.
        Neurogastroenterol Motil. 2019; 31e13483
        • Palsson O.S.
        • Whitehead W.
        • Tornblom H.
        • et al.
        Prevalence of Rome IV functional bowel disorders among adults in the United States, Canada, and the United Kingdom.
        Gastroenterology. 2020; 158: 1262-1273 e3
        • Halder S.L.
        • Locke 3rd, G.R.
        • Schleck C.D.
        • et al.
        Natural history of functional gastrointestinal disorders: a 12-year longitudinal population-based study.
        Gastroenterology. 2007; 133: 799-807