Distinctive clinical, psychological, and histological features of postinfective irritable bowel syndrome

Am J Gastroenterol. 2003 Jul;98(7):1578-83. doi: 10.1111/j.1572-0241.2003.07542.x.


Objective: Irritable bowel syndrome after gastroenteritis is well recognized. Our aim was to determine whether postinfective IBS (PI-IBS) has histological or clinical features that are distinct from those of IBS patients with no history of preceding infection.

Methods: A total of 75 consecutive IBS outpatients and 36 healthy control subjects completed a questionnaire detailing symptoms, mode of onset, and previous psychiatric history. All underwent a full diagnostic workup including rectal biopsy, which included immunostaining and quantification for lamina propria or intraepithelial T lymphocytes, serotonin-containing enterochromaffin (EC), and mast cells. Patients were divided according to onset of symptoms into PI-IBS (n = 23) or non-PI-IBS (n = 52) patients.

Results: Diarrhea predominance occurred more frequently in PI-IBS (70%) than in non-PI-IBS (42%) patients (p = 0.03). A history of previous treatment for anxiety or depression was present in 26% of PI-IBS patients compared to 54% of non-PI-IBS (p = 0.02). Biopsy results for all patients were normal using conventional criteria; however, quantification revealed that PI-IBS showed increased EC cells compared to those of non-PI-IBS patients (p = 0.017) and controls (p = 0.02). Lamina propria T lymphocytes were increased in PI-IBS (p = 0.026) and non-PI-IBS (p = 0.011) patients compared to controls. Mast cells were increased in non-PI-IBS patients (p = 0.054) compared to controls.

Conclusions: Individuals with PI-IBS are a clinically distinct subgroup characterized by diarrheal symptoms, less psychiatric illness, and increased serotonin-containing EC cells compared to those with non-PI-IBS.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Biopsy
  • Cell Count
  • Colonic Diseases, Functional / complications
  • Colonic Diseases, Functional / etiology*
  • Colonic Diseases, Functional / pathology
  • Colonic Diseases, Functional / psychology*
  • Diarrhea / etiology
  • Enterochromaffin Cells / metabolism
  • Enterochromaffin Cells / pathology
  • Female
  • Gastroenteritis / complications*
  • Gastroenteritis / microbiology*
  • Humans
  • Immunohistochemistry
  • Male
  • Mast Cells / pathology
  • Mental Disorders / etiology*
  • Middle Aged
  • Rectum / pathology*
  • Serotonin / metabolism
  • T-Lymphocytes / pathology


  • Serotonin