Irritable bowel syndrome after acute intestinal infection: Aspects of therapy on a clinical example

Irritable bowel syndrome (IBS) is a chronic functional bowel disorder that is common among young and working-age individuals and can significantly impact quality of life. Among the etiopathogenetic aspects of IBS development, the most important are intestinal motility disorders, visceral hypersensitivity, and intestinal microbiome disorders. A previous acute intestinal infection can have a significant impact on the latter, subsequently forming a post-infectious variant of IBS (PI-IBS), the frequency of which depends on what etiological factor led to the development of acute infectious gastroenteritis (bacteria, viruses, protozoa). Risk factors for the development of PI-IBS have been studied and described, among which are the severity of intestinal infection, duration of diarrhea for more than 7 days, female gender, level of anxiety and depression. Approaches to the treatment of PI-IBS have not been developed. It is proposed to use treatment options that are consistent with approaches to non-infectious IBS in accordance with the Rome Consensus IV. The first-line drugs for pain relief are antispasmodics, which reduce the tone and contractility of the smooth muscles of the intestine, effectively coping with abdominal pain. The drug of choice for patients with PI-IBS are calcium channel blockers, namely Otilonium bromide, which is widely used worldwide, is effective and safe, has additional antibacterial and antimycotic properties, is well tolerated and is superior to placebo in reducing symptoms and preventing relapse of pain in patients with IBS. In the therapy of PI-IBS, the use of rifaximin and probiotic preparations for at least 12 weeks is of great importance. This article provides a review of the literature on the prevalence and etiopathogenetic aspects of PI-IBS, as well as possible approaches to the treatment of such patients. A clinical case is presented.

1. Sperber AD, Bangdiwala SI, Drossman DA, Ghoshal UC, Simren M, Tack J et al. Worldwide prevalence and burden of functional gastrointestinal disorders, results of rome foundation global study. Gastroenterology. 2021;160(1):99–114.e3. https://doi.org/10.1053/j.gastro.2020.04.014.

2. Tornkvist NT, Aziz I, Whitehead WE, Sperber AD, Palsson OS, Hreinsson JP et al. Health care utilization of individuals with Rome IV irritable bowel syndrome in the general population. United Eur Gastroenterol J. 2021;9(10):1178–1188. https://doi.org/10.1002/ueg2.12153.

3. Yu V, Ballou S, Hassan R, Singh P, Shah E, Rangan V et al. Abdominal pain and depression, not bowel habits, predict health care utilization in patients with functional bowel disorders. Am J Gastroenterol. 2021;116(8):1720–1726. https://doi.org/10.14309/ajg.0000000000001306.

4. Ивашкин ВТ, Шелыгин ЮА, Баранов АА, Намазова-Баранова ЛС, Ачкасов СИ, Алексеева ОП. Синдром раздраженного кишечника: клинические рекомендации. 2024. Режим доступа: https://cr.minzdrav.gov.ru/preview-cr/892_1.

5. Fichna J, Storr MA. Brain-Gut Interactions in IBS. Front Pharmacol. 2012;5(3):127. https://doi.org/10.3389/fphar.2012.00127.

6. Osadchuk MA, Burdina VO. New pathogenetic approaches to the treatment of irritable bowel syndrome based on morphofunctional peculiarities of this pathology. Practical Medicine. 2014;77(1):12–20. (In Russ.) Available at: https://pmarchive.ru/prakticheskaya-medicina-1-77-gastroenterologiya.

7. Ivashkin VT, Maev IV, Shelygin YuA, Baranskaya EK, Belous SS, Belousova EA et al. Diagnosis and Treatment of Irritable Bowel Syndrome: Clinical Recommendations of the Russian Gastroenterological Association and Association of Coloproctologists of Russia. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2021;31(5):74–95. (In Russ.) https://doi.org/10.22416/1382-4376-2021-31-5-74-95.

8. Waehrens R, Ohlsson H, Sundquist J, Sundquist K, Zöller B. Risk of irritable bowel syndrome in first-degree, second-degree and third-degree relatives of affected individuals: a nationwide family study in Sweden. Gut. 2015;64(2):215–221. https://doi.org/10.1136/gutjnl-2013-305705.

9. Creed F. Review article: the incidence and risk factors for irritable bowel syndrome in population-based studies. Aliment Pharmacol Ther. 2019;50(5): 507–516. https://doi.org/10.1111/apt.15396.

10. Barbara G, Grover M, Bercik P, Corsetti M, Ghoshal UC, Ohman L, Rajilić-Stojanović M. Rome foundation working team report on postinfection irritable bowel syndrome. Gastroenterology. 2019;156(1):46–58. e7. https://doi.org/10.1053/j.gastro.2018.07.011.

11. Riddle MS, Connor P, Porter CK. Montezuma’s revenge – the sequel: The onehundred year anniversary of the first description of “post-infectious” irritable bowel syndrome. World J Gastroenterol. 2018;24(45):5076–5080. https://doi.org/10.3748/wjg.v24.i45.5076.

12. Chaudhary NA, Truelove SC. The irritable colon syndrome. A study of the clinical features, predisposing causes, and prognosis in 130 cases. Q J Med. 1962;31:307–322. Available at: https://pubmed.ncbi.nlm.nih.gov/13878459.

13. Dai C, Jiang M. The incidence and risk factors of post-infectious irritable bowel syndrome: a meta-analysis. Hepatogastroenterology. 2012;59(113):67–72. https://doi.org/10.5754/hge10796.

14. Klem F, Wadhwa A, Prokop LJ, Sundt WJ, Farrugia G, Camilleri M et al. Prevalence, risk factors, and outcomes of irritable bowel syndrome after infectious enteritis: a systematic review and meta-analysis. Gastroenterology. 2017;152(5):1042–1054. https://doi.org/10.1053/j.gastro.2016.12.039.

15. Zanini B, Ricci C, Bandera F, Caselani F, Magni A, Laronga AM et al. Incidence of post-infectious irritable bowel syndrome and functional intestinal disorders following a water-borne viral gastroenteritis outbreak. Am J Gastroenterol. 2012;107(6):891–898. https://doi.org/10.1038/ajg.2012.102.

16. Noviello D, Costantino A, Muscatello A, Bandera A, Consonni D, Vecchi M, Basilisko G. Functional gas trointestinal and somatoform symptoms four month after SARS-CoV-2 infection: A controlled cohort study. Neurogastroenterol Motil. 2021;34(2):e14187. https://doi.org/10.1111/nmo.14187.

17. Mearin F, Lacy BE, Chang L, Chey WD, Lembo AJ, Simren M, Spiller R. Bowel disorders. Gastroenterology. 2016;150(6):1393–1407.e5. https://doi.org/10.1053/j.gastro.2016.02.031.

18. Simren M, Tornblom H, Palsson OS, Van Oudenhove L, Whitehead WE, Tack J. Cumulative effects of psychologic distress, visceral hypersensitivity, and abnormal transit on patient-reported outcomes in irritable bowel syndrome. Gastroenterology. 2019;157(2):391–402.e2. https://doi.org/10.1053/j.gastro.2019.04.019.

19. Nozu T, Kudaira M. Altered rectal sensory response induced by balloon distention in patients with functional abdominal pain syndrome. Biopsychosoc Med. 2009;3(1):13. https://doi.org/10.1186/1751-0759-3-13.

20. Drossman DA. Functional gastrointestinal disorders: history, pathophysiology, clinical features, and Rome IV. Gastroenterology. 2016;150(6):1262–1279. https://doi.org/10.1053/j.gastro.2016.02.032.

21. Wang LH, Fang XC, Pan GZ. Bacillary dysentery as a causative factor of irritable bowel syndrome and its pathogenesis. Gut. 2004;53(8):1096–1101. https://doi.org/10.1136/gut.2003.021154.

22. van der Veek PP, van den Berg M, de Kroon YE, Verspaget HW, Masclee AA. Role of tumor necrosis factor-alpha and interleukin-10 gene polymorphisms in irritable bowel syndrome. Am J Gastroenterol. 2005;100(11):2510–2516. https://doi.org/10.1111/j.1572-0241.2005.00257.x.

23. Sykes MA, Blanchard EB, Lackner J, Keefer L, Krasner S. Psychopathology in irritable bowel syndrome: support for a psychophysiological model. J Behav Med. 2003;26(4):361–372. https://doi.org/10.1023/a:1024209111909.

24. Spence MJ, Moss-Morris R. The cognitive behavioural model of irritable bowel syndrome: a prospective investigation of patients with gastroenteritis. Gut. 2007;56(8):1066–1071. https://doi.org/10.1136/gut.2006.108811.

25. Bohn L, Storsrud S, Tornblom H, Bengtsson U, Simrén M. Self-reported food-related gastrointestinal symptoms in IBS are common and associated with more severe symptoms and reduced quality of life. Am J Gastroenterol. 2013;108(5):634–641. https://doi.org/10.1038/ajg.2013.105.

26. Staudacher HM, Rossi M, Kaminski T, Dimidi E, Ralph FSE, Wilson B et al. Longterm personalized low FODMAP diet improves symptoms and maintains luminal Bifidobacteria abundance in irritable bowel syndrome. Neurogastroenterol Motil. 2022;34(4):e14241. https://doi.org/10.1111/nmo.14241.

27. Black CJ, Staudacher HM, Ford AC. Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis. Gut. 2022;71(6):1117–1126. https://doi.org/10.1136/gutjnl-2021-325214.

28. Ruepert L, Quartero AO, Wit de NJ, Heijden van der GJ, Rubin G, Muris JW. Bulking agents, antispasmodics and antidepressants for the treatment of irritable bowel syndrome. The Cochrane Collaboration. Cochrane Database Syst Rev. 2011;8(8):CD003460. https://doi.org/10.1002/14651858.CD003460.pub3.

29. Clavé P, Acalovschi M, Triantafillidis JK, Uspensky YP, Kalayci C, Shee V, Tack J. Randomised clinical trial: otilonium bromide improves frequency of abdominal pain, severity of distention and time to relapse in patients with irritable bowel syndrome. Aliment Pharmacol Ther. 2011;34(4):432–442. https://doi.org/10.1111/j.1365-2036.2011.04730.x.

30. Glende M, Morselli-Labate AM, Battaglia G, Evangelista S. Extended analysis of a double-blind, placebo-controlled, 15-week study with otilonium bromide in irritable bowel syndrome. Eur J Gastroenterol Hepatol. 2002;14(12): 1331–1338. https://doi.org/10.1097/00042737-200212000-00008.

31. Khrutskaya MS, Semenyako SV, Bobrovskaya EI, Parfenenko TV. Effect of otilonium bromide on intensity of chronic abdominal pain. Meditsinskie Novosti. 2014;(3):59–61. (In Russ.) Available at: https://cyberleninka.ru/article/n/vliyanie-otiloniya-bromidana-intensivnost-hronicheskoyabdominalnoy-boli/viewer.

32. Zhou L, She P, Tan F, Li S, Zeng X, Chen L et al. Repurposing Antispasmodic Agent Otilonium Bromide for Treatment of Staphylococcus aureus Infections. Front Microbiol. 2020;11:1720. https://doi.org/10.3389/fmicb.2020.01720.

33. Zhen C, Wang L, Feng Y, Whiteway M, Hang S, Yu J et al. Otilonium Bromide Exhibits Potent Antifungal Effects by Blocking Ergosterol Plasma Membrane Localization and Triggering Cytotoxic Autophagy in Candida Albicans. Adv Sci. 2024;11(35):e2406473. https://doi.org/10.1002/advs.202406473.

34. Jin Y, Ren X, Li G, Li Y, Zhang L, Wang H et al. Beneficial effects of Rifaximin in post-infectious irritable bowel syndrome mouse model beyond gut microbiota. J Gastroenterol Hepatol. 2018;33(2):443–452. https://doi.org/10.1111/jgh.13841.

35. Ford AC, Harris LA, Lacy BE, Quigley EMM, Moayyedi P. Systematic review with meta-analysis: the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndrome. Aliment Pharmacol Ther. 2018;48(10):1044–1060. https://doi.org/10.1111/apt.15001.