Estimating the Contribution of Acute Gastroenteritis to the Overall Prevalence of Irritable Bowel Syndrome

BACKGROUND/AIMS: Recent studies reveal that acute gastroenteritis can precipitate irritable bowel syndrome (IBS) symptoms leading to the concept of post-infectious IBS. However, the overall contribution of gastroenteritis to the total IBS prevalence is unknown. In this exercise we try to estimate the contribution of gastroenteritis in IBS using the published literature and a longitudinal approach. METHODS: Existing literature was reviewed to determine the incidence of IBS after gastroenteritis, the rate of remission over time, data on rates of gastroenteritis in a given population and any patterns of resistance to these effects in human populations. This produced 3 models. The first assumed all humans were susceptible to gastroenteritis and its ability to produce IBS. The second assumed (using meta-analysis data) that 90% of humans in a given outbreak would be resistant to this effect. The third model used a high gastroenteritis exposure rate as might be seen in military deployment. RESULTS: In model 1, the prevalence was unrealistically high with an eventual steady state of 43.6% of the population affected by IBS. In a very conservative approach (model 2), steady state was achieved after 10 years to an overall prevalence of 8.9%. Interestingly, based on a high 1 year exposure rate such as military deployment, the maximum prevalence (steady state) was reached before 1 year suggesting high risk. CONCLUSIONS: Although hypothetical in approach, based on conservative estimates in existing literature the contribution of gastroenteritis to the overall prevalence of IBS is substantial.

review of cryptosporidiosis in Egypt

Cryptosporidiosis, a parasitic zoonosis, while typically a short-term infection, has a global distribution and can cause severe ill-ness in children and other vulnerable populations. In order to inform local and regional public health personnel and providers, the authors conducted a comprehensive review of Cryptosporidium parvum [Cp] epidemiology in Egypt to establish what is Known, identify critical Knowledge gaps, and develop a basis for future directions in mitigating the burden associated with this illness among Egyptians and similar countries. A total of 61 published studies between 1985 and 2006 were reviewed. Nineteen studies examined immunocompetent individuals with diarrhea presenting to inpatient or outpatient clinics with a Cp prevalence ranging from 0% - 47% [median 9%, IQR 3-15%]. Identified risk factors, at risk populations, ecology, environmental findings, as well as a quality assessment of the published literature are discussed. The building blocks are in place to design studies aimed at defining the disease, societal burden and evaluating public health interventions aimed at disrupting water and zoonotic transmission modalities using the most current molecular techniques. Cp diarrhea is but one of the many causes of diarrhea among Egyptians, but efforts to control this disease should also serve well to mitigate a number of infectious causes of diarrhea and given the track record of previous work hopping to see advances in the near future