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Long-Term Gastrointestinal Consequences are Frequent Following Sporadic Acute Infectious Diarrhea in a Tropical Country: A Prospective Cohort Study.
Am J Gastroenterol. 2018 09; 113(9):1363-1375.AJ

Abstract

BACKGROUND

Postinfection irritable bowel syndrome (PI-IBS) and functional dyspepsia (PI-FD), though reported from the temperate countries, have not been studied in the tropics; PI-malabsorption syndrome (MAS), which mimics PI-IBS, is reported from the tropics. No report till date on PI-IBS excluded PI-MAS. We studied: (i) the frequency of continuing bowel dysfunction after acute gastroenteritis (AG), (ii) its predictors, and (iii) PI-MAS among patients with PI-IBS.

METHODS

345 consecutive subjects each, with AG and age- and gender-matched healthy controls were followed up 3-monthly for 12 months using a translated-validated questionnaire and functional gastrointestinal disorders (FGIDs) were diagnosed by Rome III criteria. Symptom duration >3 months but <6 months was diagnosed as chronic bowel dysfunction (CBD) and dyspeptic symptoms, respectively. MAS was diagnosed if 2/3 tests (D-xylose H2 breath test, Sudan III-stained stool microscopy, and duodenal histology) were abnormal. Fecal microbiological studies were performed in 245/345 (71%) patients.

RESULTS

AG patients more often developed PI-IBS and PI-FD than controls (16.5 vs. 2.6% and 7.4 vs. 0.6%, respectively; p<0.001). Presence of FD was a risk factor for PI-IBS and IBS for PI-FD. On multivariate analysis, dyspeptic symptoms, CBD, and weight loss were the risk factors for PI-FGIDs. The frequency of PI-IBS following Vibrio cholera and other bacterial infection was comparable. Malabsorption was present among 2/23 (9%) patients with PI-IBS.

CONCLUSION

FGIDs are common after AG; dyspeptic symptoms, CBD, and weight loss were risk factors for PI-FGIDs. Vibrio cholerae infection caused PI-FGID, which was never reported. About 9 % patients fulfilling the criteria for PI-IBS had PI-MAS.

Authors+Show Affiliations

Department of Gastroenterology, Dhaka Medical College and Hospital, Dhaka, Bangladesh. Department of Gastroenterology, Sanjay Gandhi Postgraduate institute of Medical sciences, Lucknow, india. Nutrition and clinical service division, international center for diarrheal disease Research, dhaka, Bangladesh. Gastroliver Foundation, dhaka, Bangladesh. These authors contributed equally: M. Masudur rahman, uday c. ghoshal.Department of Gastroenterology, Dhaka Medical College and Hospital, Dhaka, Bangladesh. Department of Gastroenterology, Sanjay Gandhi Postgraduate institute of Medical sciences, Lucknow, india. Nutrition and clinical service division, international center for diarrheal disease Research, dhaka, Bangladesh. Gastroliver Foundation, dhaka, Bangladesh. These authors contributed equally: M. Masudur rahman, uday c. ghoshal.Department of Gastroenterology, Dhaka Medical College and Hospital, Dhaka, Bangladesh. Department of Gastroenterology, Sanjay Gandhi Postgraduate institute of Medical sciences, Lucknow, india. Nutrition and clinical service division, international center for diarrheal disease Research, dhaka, Bangladesh. Gastroliver Foundation, dhaka, Bangladesh. These authors contributed equally: M. Masudur rahman, uday c. ghoshal.Department of Gastroenterology, Dhaka Medical College and Hospital, Dhaka, Bangladesh. Department of Gastroenterology, Sanjay Gandhi Postgraduate institute of Medical sciences, Lucknow, india. Nutrition and clinical service division, international center for diarrheal disease Research, dhaka, Bangladesh. Gastroliver Foundation, dhaka, Bangladesh. These authors contributed equally: M. Masudur rahman, uday c. ghoshal.Department of Gastroenterology, Dhaka Medical College and Hospital, Dhaka, Bangladesh. Department of Gastroenterology, Sanjay Gandhi Postgraduate institute of Medical sciences, Lucknow, india. Nutrition and clinical service division, international center for diarrheal disease Research, dhaka, Bangladesh. Gastroliver Foundation, dhaka, Bangladesh. These authors contributed equally: M. Masudur rahman, uday c. ghoshal.Department of Gastroenterology, Dhaka Medical College and Hospital, Dhaka, Bangladesh. Department of Gastroenterology, Sanjay Gandhi Postgraduate institute of Medical sciences, Lucknow, india. Nutrition and clinical service division, international center for diarrheal disease Research, dhaka, Bangladesh. Gastroliver Foundation, dhaka, Bangladesh. These authors contributed equally: M. Masudur rahman, uday c. ghoshal.Department of Gastroenterology, Dhaka Medical College and Hospital, Dhaka, Bangladesh. Department of Gastroenterology, Sanjay Gandhi Postgraduate institute of Medical sciences, Lucknow, india. Nutrition and clinical service division, international center for diarrheal disease Research, dhaka, Bangladesh. Gastroliver Foundation, dhaka, Bangladesh. These authors contributed equally: M. Masudur rahman, uday c. ghoshal.Department of Gastroenterology, Dhaka Medical College and Hospital, Dhaka, Bangladesh. Department of Gastroenterology, Sanjay Gandhi Postgraduate institute of Medical sciences, Lucknow, india. Nutrition and clinical service division, international center for diarrheal disease Research, dhaka, Bangladesh. Gastroliver Foundation, dhaka, Bangladesh. These authors contributed equally: M. Masudur rahman, uday c. ghoshal.Department of Gastroenterology, Dhaka Medical College and Hospital, Dhaka, Bangladesh. Department of Gastroenterology, Sanjay Gandhi Postgraduate institute of Medical sciences, Lucknow, india. Nutrition and clinical service division, international center for diarrheal disease Research, dhaka, Bangladesh. Gastroliver Foundation, dhaka, Bangladesh. These authors contributed equally: M. Masudur rahman, uday c. ghoshal.Department of Gastroenterology, Dhaka Medical College and Hospital, Dhaka, Bangladesh. Department of Gastroenterology, Sanjay Gandhi Postgraduate institute of Medical sciences, Lucknow, india. Nutrition and clinical service division, international center for diarrheal disease Research, dhaka, Bangladesh. Gastroliver Foundation, dhaka, Bangladesh. These authors contributed equally: M. Masudur rahman, uday c. ghoshal.

Pub Type(s)

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

Language

eng

PubMed ID

30171215

Citation

Rahman, Masudur M., et al. "Long-Term Gastrointestinal Consequences Are Frequent Following Sporadic Acute Infectious Diarrhea in a Tropical Country: a Prospective Cohort Study." The American Journal of Gastroenterology, vol. 113, no. 9, 2018, pp. 1363-1375.
Rahman MM, Ghoshal UC, Sultana S, et al. Long-Term Gastrointestinal Consequences are Frequent Following Sporadic Acute Infectious Diarrhea in a Tropical Country: A Prospective Cohort Study. Am J Gastroenterol. 2018;113(9):1363-1375.
Rahman, M. M., Ghoshal, U. C., Sultana, S., Kibria, M. G., Sultana, N., Khan, Z. A., Ahmed, F., Hasan, M., Ahmed, T., & Sarker, S. A. (2018). Long-Term Gastrointestinal Consequences are Frequent Following Sporadic Acute Infectious Diarrhea in a Tropical Country: A Prospective Cohort Study. The American Journal of Gastroenterology, 113(9), 1363-1375. https://doi.org/10.1038/s41395-018-0208-3
Rahman MM, et al. Long-Term Gastrointestinal Consequences Are Frequent Following Sporadic Acute Infectious Diarrhea in a Tropical Country: a Prospective Cohort Study. Am J Gastroenterol. 2018;113(9):1363-1375. PubMed PMID: 30171215.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-Term Gastrointestinal Consequences are Frequent Following Sporadic Acute Infectious Diarrhea in a Tropical Country: A Prospective Cohort Study. AU - Rahman,Masudur M, AU - Ghoshal,Uday Chand, AU - Sultana,Shamima, AU - Kibria,Md Golam, AU - Sultana,Nigar, AU - Khan,Zeenat Arefin, AU - Ahmed,Faruque, AU - Hasan,Mahmud, AU - Ahmed,Tahmeed, AU - Sarker,Shafiqul Alam, Y1 - 2018/08/31/ PY - 2017/12/30/received PY - 2018/06/07/accepted PY - 2018/9/2/pubmed PY - 2019/9/7/medline PY - 2018/9/2/entrez SP - 1363 EP - 1375 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 113 IS - 9 N2 - BACKGROUND: Postinfection irritable bowel syndrome (PI-IBS) and functional dyspepsia (PI-FD), though reported from the temperate countries, have not been studied in the tropics; PI-malabsorption syndrome (MAS), which mimics PI-IBS, is reported from the tropics. No report till date on PI-IBS excluded PI-MAS. We studied: (i) the frequency of continuing bowel dysfunction after acute gastroenteritis (AG), (ii) its predictors, and (iii) PI-MAS among patients with PI-IBS. METHODS: 345 consecutive subjects each, with AG and age- and gender-matched healthy controls were followed up 3-monthly for 12 months using a translated-validated questionnaire and functional gastrointestinal disorders (FGIDs) were diagnosed by Rome III criteria. Symptom duration >3 months but <6 months was diagnosed as chronic bowel dysfunction (CBD) and dyspeptic symptoms, respectively. MAS was diagnosed if 2/3 tests (D-xylose H2 breath test, Sudan III-stained stool microscopy, and duodenal histology) were abnormal. Fecal microbiological studies were performed in 245/345 (71%) patients. RESULTS: AG patients more often developed PI-IBS and PI-FD than controls (16.5 vs. 2.6% and 7.4 vs. 0.6%, respectively; p<0.001). Presence of FD was a risk factor for PI-IBS and IBS for PI-FD. On multivariate analysis, dyspeptic symptoms, CBD, and weight loss were the risk factors for PI-FGIDs. The frequency of PI-IBS following Vibrio cholera and other bacterial infection was comparable. Malabsorption was present among 2/23 (9%) patients with PI-IBS. CONCLUSION: FGIDs are common after AG; dyspeptic symptoms, CBD, and weight loss were risk factors for PI-FGIDs. Vibrio cholerae infection caused PI-FGID, which was never reported. About 9 % patients fulfilling the criteria for PI-IBS had PI-MAS. SN - 1572-0241 UR - https://www.unboundmedicine.com/medline/citation/30171215/Long_Term_Gastrointestinal_Consequences_are_Frequent_Following_Sporadic_Acute_Infectious_Diarrhea_in_a_Tropical_Country:_A_Prospective_Cohort_Study_ L2 - http://Insights.ovid.com/pubmed?pmid=30171215 DB - PRIME DP - Unbound Medicine ER -