Can irritable bowel syndrome (IBS) start with a gut infection?

An infection of the gut is an important internal trigger/stressor that can mark the onset of irritable bowel syndrome (IBS). A recent scientific study confirms previous studies as well as the clinical experience of gastroenterologists: about a quarter to a third of patients with diarrhea predominant IBS report a previous history of an acute gastroenteritis. Risk factors for developing this "post-infectious IBS" include female sex, anxiety, depression, having other chronic functional symptoms and/or syndromes and adverse stressful life experiences in the previous year.

Furthermore, the longer the initial illness, the more likely it was that IBS developed. For example, the risk was more than ten times greater if the initial diarrhea lasted for more than 21 days compared with diarrhea lasting less than seven days. Medical tests, such as biopsies of the digestive tract, are normal in people with IBS.

But some patients with post-infectious IBS do have colon biopsies that show an increase of what are called chronic inflammatory cells when viewed through a microscope, even though the appearance of the bowel is normal when viewed through a colonoscope. The evidence is accumulating that the bad stress response can increase susceptibility to the development of IBS following exposure to the "threat" of an infectious internal stressor/trigger. Furthermore, the bad stress response may persist as a result of the triggering infection.

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