GI symptoms can persist a decade after intestinal infections

Thirty percent of individuals with a history of Salmonella or Campylobacter infections reported ongoing post infectious symptoms as long as 10 years after the initial infectious event, the results in a poster at the meeting.

“These patients represent a clinically important population with high somatization, anxiety, and depression scores.”

Surveys were sent to 576 people who had come to University Hospital Tubingen between 2000 and mid-2009 and had documented Salmonella or Campylobacter gastrointestinal infection. A total of 189 (36%) responded to the brief survey, which asked about current GI symptoms and whether respondents would be willing to participate in a further investigation of their infection history and consequences.

Of the 189 survey respondents, 56 people (30%) indicated that they were still symptomatic (end of 2009). The 56 patients included 6 patients originally infected in 2000, 5 patients infected in 2001, and 2 infected in 2002.

The average age of the respondents at the time of infection was 39.8 years, and at the time of survey it was 43.1 years. Thirty-two patients had a history of Salmonella, and 24 had a history of Campylobacter.

Symptomatic individuals were then sent a second, more extensive questionnaire that focused on postinfectious irritable bowel syndrome (PI-IBS). This survey was developed and validated by European Society of Neurogastroenterology and Motility. Ninety-one percent (51 patients) responded to the second survey. The majority of the sample (69% or 35 patients) met criteria for PI-IBS, which includes the presence of two or more symptoms such as sudden-onset fever, diarrhea, vomiting, or bloody stools. Overall, 84% (43/51) were symptomatic during the preceding 9 months. Almost one-third (16) met Rome IBS criteria, but only 7 (14%) had met Rome IBS criteria before the infection.

No link was observed between having IBS symptoms before infection and developing PI-IBS. Neither age nor gender predicted development of PI-IBS, and no association was found between the initial bacteria strain and the risk of developing PI-IBS.

Those respondents with PI-IBS reported significantly more depression, and had higher somatization scores than did those without PI-IBS. “It needs to be shown whether and which individual premorbid and postinfectious clinical factors may explain symptom persistence, and whether long-term development of postinfectious symptoms maybe prevented by early postinfection interventions.