Gastrointestinal Symptoms After Infectious Diarrhea: A Five-Year Follow-Up in a Swedish Cohort of Adults

Background & Aims: Gastrointestinal infection is a well-recognized trigger for functional bowel disorder. This study evaluated gastrointestinal symptoms and risk factors for their development after diarrheal disease of proven or strongly suspected infectious etiology in adults. Methods: The cohort of patients was derived from a previous study that determined the rate at which enteropathogens could be isolated at the time of diarrheal disease in adults. After 5 years, 717 of 851 patients were accessible for a questionnaire asking for persistence of gastrointestinal symptoms. Results: Of 508 returned questionnaires, 333 were from patients with no previous gastrointestinal complaints. Forty-one (12%) of them had gastrointestinal symptoms for 3 months or more after the infectious diarrhea, and 31 (9%) still had symptoms at the end of the follow-up period. Irritable bowel syndrome was most common (68%), but other functional bowel disorder diagnoses were found in all but one of the others. Female gender (odds ratio, 2.65, 95% confidence interval, 1.28-5.50) and use of antibiotic treatment (odds ratio, 2.37; 95% confidence interval, 1.07-5.25) were risk factors for development of postinfectious functional bowel disorder. No increase in risk was associated with the type of enteropathogen causing diarrhea. Conclusions: Infectious diarrhea in previously healthy adults carried a substantial risk of triggering postinfectious functional bowel disorder. Irritable bowel syndrome was the most common, but other functional bowel disorders were also found. We did not find any new clinical tools that would facilitate the prediction of long-standing symptoms.