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Incidence of post-infectious irritable bowel syndrome and functional intestinal disorders following a water-borne viral gastroenteritis outbreak.
Am J Gastroenterol. 2012 Jun; 107(6):891-9.AJ

Abstract

OBJECTIVES

Post-infectious irritable bowel syndrome (PI-IBS) may develop in 4-31% of affected patients following bacterial gastroenteritis (GE), but limited information is available on long-term outcome of viral GE. During summer 2009, a massive outbreak of viral GE associated with contamination of municipal drinking water (Norovirus) occurred in San Felice del Benaco (Lake Garda, Italy). To investigate the natural history of a community outbreak of viral GE, and to assess the incidence of PI-IBS and functional gastrointestinal disorders, we carried out a prospective population-based cohort study with a control group.

METHODS

Baseline questionnaires were administered to the resident community within 1 month of the outbreak. Follow-up questionnaires of the Italian version of Gastrointestinal Symptom Rating Scale (GSRS, a 15-item survey scored according to a 7-point Likert scale) were mailed to all patients responding to baseline questionnaire at 3 and 6 months, and to a cohort of unaffected controls, living in the same geographical area, at 6 months after the outbreak. The GSRS item were grouped in five dimensions: abdominal pain, reflux, indigestion, diarrhea, and constipation. At month 12, all patients and controls were interviewed by a health assistant to verify Rome III criteria of IBS. Student's t-test and χ(2)- or Fisher's exact test were used as appropriate.

RESULTS

Baseline questionnaires were returned by 348 patients: mean age ± s.d. 45 ± 22 years, 53% female. At outbreak, nausea (scored ≥4), vomiting, and diarrhea lasting 2-3 days or more were reported by 66, 60, and 77% of patients, respectively. A total of 50% reported fever and 19% reported weight loss (mean 3 kg). Follow-up surveys were returned at month 6 by 186 patients and 198 controls: mean GSRS score was significantly higher in patients than in controls for abdominal pain, diarrhea, and constipation. At month 12, we identified 40 patients with a new diagnosis of IBS (Rome III criteria), in comparison with 3 subjects in the control cohort (P<0.0001; odds ratio 11.40; 95% confidence intervals 3.44-37.82). The 40 cases of PI-IBS were subtyped according to the predominant stool pattern as follows: 4 IBS with constipation, 7 IBS with diarrhea, 16 with mixed IBS, and 13 with unsubtyped IBS.

CONCLUSIONS

Our study provides evidence that Norovirus GE leads to the development of PI-IBS in a substantial proportion of patients (13%), similar to that reported after bacterial GE.

Authors+Show Affiliations

Department of Medical and Surgical Sciences, Gastroenterology Unit, University and Spedali Civili of Brescia, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22525306

Citation

Zanini, Barbara, et al. "Incidence of Post-infectious Irritable Bowel Syndrome and Functional Intestinal Disorders Following a Water-borne Viral Gastroenteritis Outbreak." The American Journal of Gastroenterology, vol. 107, no. 6, 2012, pp. 891-9.
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(6):891-9.
Zanini, B., Ricci, C., Bandera, F., Caselani, F., Magni, A., Laronga, A. M., & Lanzini, A. (2012). Incidence of post-infectious irritable bowel syndrome and functional intestinal disorders following a water-borne viral gastroenteritis outbreak. The American Journal of Gastroenterology, 107(6), 891-9. https://doi.org/10.1038/ajg.2012.102
Zanini B, 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(6):891-9. PubMed PMID: 22525306.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incidence of post-infectious irritable bowel syndrome and functional intestinal disorders following a water-borne viral gastroenteritis outbreak. AU - Zanini,Barbara, AU - Ricci,Chiara, AU - Bandera,Floriana, AU - Caselani,Francesca, AU - Magni,Alberto, AU - Laronga,Anna Maria, AU - Lanzini,Alberto, AU - ,, Y1 - 2012/04/24/ PY - 2012/4/25/entrez PY - 2012/4/25/pubmed PY - 2012/9/7/medline SP - 891 EP - 9 JF - The American journal of gastroenterology JO - Am J Gastroenterol VL - 107 IS - 6 N2 - OBJECTIVES: Post-infectious irritable bowel syndrome (PI-IBS) may develop in 4-31% of affected patients following bacterial gastroenteritis (GE), but limited information is available on long-term outcome of viral GE. During summer 2009, a massive outbreak of viral GE associated with contamination of municipal drinking water (Norovirus) occurred in San Felice del Benaco (Lake Garda, Italy). To investigate the natural history of a community outbreak of viral GE, and to assess the incidence of PI-IBS and functional gastrointestinal disorders, we carried out a prospective population-based cohort study with a control group. METHODS: Baseline questionnaires were administered to the resident community within 1 month of the outbreak. Follow-up questionnaires of the Italian version of Gastrointestinal Symptom Rating Scale (GSRS, a 15-item survey scored according to a 7-point Likert scale) were mailed to all patients responding to baseline questionnaire at 3 and 6 months, and to a cohort of unaffected controls, living in the same geographical area, at 6 months after the outbreak. The GSRS item were grouped in five dimensions: abdominal pain, reflux, indigestion, diarrhea, and constipation. At month 12, all patients and controls were interviewed by a health assistant to verify Rome III criteria of IBS. Student's t-test and χ(2)- or Fisher's exact test were used as appropriate. RESULTS: Baseline questionnaires were returned by 348 patients: mean age ± s.d. 45 ± 22 years, 53% female. At outbreak, nausea (scored ≥4), vomiting, and diarrhea lasting 2-3 days or more were reported by 66, 60, and 77% of patients, respectively. A total of 50% reported fever and 19% reported weight loss (mean 3 kg). Follow-up surveys were returned at month 6 by 186 patients and 198 controls: mean GSRS score was significantly higher in patients than in controls for abdominal pain, diarrhea, and constipation. At month 12, we identified 40 patients with a new diagnosis of IBS (Rome III criteria), in comparison with 3 subjects in the control cohort (P<0.0001; odds ratio 11.40; 95% confidence intervals 3.44-37.82). The 40 cases of PI-IBS were subtyped according to the predominant stool pattern as follows: 4 IBS with constipation, 7 IBS with diarrhea, 16 with mixed IBS, and 13 with unsubtyped IBS. CONCLUSIONS: Our study provides evidence that Norovirus GE leads to the development of PI-IBS in a substantial proportion of patients (13%), similar to that reported after bacterial GE. SN - 1572-0241 UR - https://www.unboundmedicine.com/medline/citation/22525306/Incidence_of_post_infectious_irritable_bowel_syndrome_and_functional_intestinal_disorders_following_a_water_borne_viral_gastroenteritis_outbreak_ L2 - https://Insights.ovid.com/pubmed?pmid=22525306 DB - PRIME DP - Unbound Medicine ER -