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POST INFECTIOUS IBS (PI-IBS)

Acute intestinal infection (gastroenteritis) is a common event, in the UK there are approximately 17 million cases per year. Although most cases make a full recovery, in some patients symptoms can persist for many years. Post infectious IBS (PI-IBS) develops in approximately 10% of patients who have experienced an episode of acute infectious gastroenteritis; this is the strongest known risk factor for IBS development1.

HOW DOES PI-IBS DEVELOP?

The mechanisms by which an intestinal infection can lead to IBS development are still not fully understood, but there is evidence to suggest that increased intestinal gut wall permeability2, changes to the microbiota (microorganisms living in the gut), altered serotonin (5-HT) metabolism3, increased numbers of a type of gut cell called enterochromaffin (EC) cells4 and T lymphocytes (immune cells)2 play a role. Different types of microorganism have been linked with PI-IBS including; bacteria, viruses, and protozoa. Although PI-IBS is more common after a bacterial infection rather than a viral infection. Recent studies have shown that PI-IBS rates are as high as 25% after an infection with Clostridium difficile6 and 16% after an infection with Vibrio cholerae7.

HOW IS PI-IBS DIAGNOSED?

Diagnosis of PI-IBS has been proposed by the Rome Foundation Working Team (RFWT) and is based on the standard Rome IV criteria which are currently used to diagnose IBS5.

1. Recurrent abdominal pain, on average, at least 1 day per week in the last 3 months, with symptom onset at least 6 months before diagnosis, associated with >2 of the following:

a) defecation
b) a change in frequency of stool
c) a change in form (appearance) of stool

2. Symptom development immediately after resolution of acute infectious gastroenteritis

3. Infectious gastroenteritis defined by positive stool culture in a symptomatic individual or presence of >2 of the following acute symptoms (when stool culture not available):

a) fever
b) vomiting
c) diarrhoea

4. Should not meet criteria for IBS before onset of acute illness (irregular bowel movements associated with frequent pain)

IBS-M is the most common subtype associated with PI-IBS followed by the IBS-D category, and the reminder (<10%) reported as IBS-C subtype. The main risk factors for developing PI-IBS following an intestinal infection include; female gender, younger age, stress during or before the episode, and the overall severity and length of the symptoms. Studies suggest that the symptoms of people with PI-IBS tend to decrease over time and therefore they have a better prognosis than those with IBS5.

It is important to treat gastroenteritis with ENTEROSGEL – a drug-free effective diarrhoea treatment.

A 2018 UK based Randomized Clinical Trial published in BMJ Open Gastroenterology, has shown that ENTEROSGEL significantly reduces the duration of diarrhoea.

DURATION OF TREATMENT WITH ENTEROSGEL®:

3–5 days for acute diarrhoea.

Dosage:

For children:

1–6 years old: 5g (approximately 1 teaspoon or 1/3
of a sachet) diluted in 50–100 ml of water 3 times a day.

7–14 years old: 10g (approximately 2 teaspoons or 2/3 of a sachet) diluted in 50–100 ml of water 3 times a day.

For children 15+ and adults
15 g to 22.5 g (approximately 1 table spoon or 1–1,5 sachet) diluted in 200 ml of water 3 times a day.

In the beginning of the treatment (on Day 1) you can double the first dose and then continue with a single dose after each bowel movement from 3 to 6 times a day. Maximum 8 doses on the first day.

1. Rubio-Tapia A, et al. Am J Gastroenterol 2013;108:656–676.
2. Gasbarrini A, et al. Aliment Pharmacol Ther 2009;29(Suppl 1):1–49.
3. Rahman M, et al. Am J Gastroenterol 2018; 113(Suppl 3):1363–1375.
4. Litleskare S, et al. Clin Gastroenterol Hepatol 2018;16:1064–1072.

5. Giovanni B, et al. Gastroenterology 2019;156:46–58
6. Wadhwa A, et al. Aliment Pharmacol Ther 2016;44:576–582.
7. Rahman M, et al. Am J Gastroenterol 2018;113(Suppl 3):1363–1375.