Prevalence, Risk Factors, and Outcomes of Irritable Bowel Syndrome After Infectious Enteritis: A Systematic Review and Meta-analysis

Gastroenterology. 2017 Apr;152(5):1042-1054.e1. doi: 10.1053/j.gastro.2016.12.039. Epub 2017 Jan 6.


Background & aims: Foodborne illness affects 15% of the US population each year, and is a risk factor for irritable bowel syndrome (IBS). We evaluated risk of, risk factors for, and outcomes of IBS after infectious enteritis.

Methods: We performed a systematic review of electronic databases from 1994 through August 31, 2015 to identify cohort studies of the prevalence of IBS 3 months or more after infectious enteritis. We used random-effects meta-analysis to calculate the summary point prevalence of IBS after infectious enteritis, as well as relative risk (compared with individuals without infectious enteritis) and host- and enteritis-related risk factors.

Results: We identified 45 studies, comprising 21,421 individuals with enteritis, followed for 3 months to 10 years for development of IBS. The pooled prevalence of IBS at 12 months after infectious enteritis was 10.1% (95% confidence interval [CI], 7.2-14.1) and at more than 12 months after infectious enteritis was 14.5% (95% CI, 7.7-25.5). Risk of IBS was 4.2-fold higher in patients who had infectious enteritis in the past 12 months than in those who had not (95% CI, 3.1-5.7); risk of IBS was 2.3-fold higher in individuals who had infectious enteritis more than 12 months ago than in individuals who had not (95% CI, 1.8-3.0). Of patients with enteritis caused by protozoa or parasites, 41.9% developed IBS, and of patients with enteritis caused by bacterial infection, 13.8% developed IBS. Risk of IBS was significantly increased in women (odds ratio [OR], 2.2; 95% CI, 1.6-3.1) and individuals with antibiotic exposure (OR, 1.7; 95% CI, 1.2-2.4), anxiety (OR, 2; 95% CI, 1.3-2.9), depression (OR, 1.5; 95% CI, 1.2-1.9), somatization (OR, 4.1; 95% CI, 2.7-6.0), neuroticism (OR, 3.3; 95% CI, 1.6-6.5), and clinical indicators of enteritis severity. There was a considerable level of heterogeneity among studies.

Conclusions: In a systematic review and meta-analysis, we found >10% of patients with infectious enteritis develop IBS later; risk of IBS was 4-fold higher than in individuals who did not have infectious enteritis, although there was heterogeneity among studies analyzed. Women-particularly those with severe enteritis-are at increased risk for developing IBS, as are individuals with psychological distress and users of antibiotics during the enteritis.

Keywords: Functional Gastrointestinal Disorders; Gastrointestinal Infections; Microbes; Post-Infectious Irritable Bowel Syndrome.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review
  • Video-Audio Media

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Anxiety / epidemiology
  • Anxiety Disorders / epidemiology
  • Bacterial Infections / epidemiology
  • Depression / epidemiology
  • Enteritis / drug therapy
  • Enteritis / epidemiology*
  • Enteritis / microbiology
  • Female
  • Foodborne Diseases / drug therapy
  • Foodborne Diseases / epidemiology*
  • Foodborne Diseases / microbiology
  • Humans
  • Intestinal Diseases, Parasitic / epidemiology
  • Irritable Bowel Syndrome / epidemiology*
  • Male
  • Neuroticism
  • Odds Ratio
  • Prevalence
  • Risk Factors
  • Severity of Illness Index
  • Sex Factors
  • Somatoform Disorders / epidemiology


  • Anti-Bacterial Agents