Letters

Prevalence of gastrointestinal symptoms after bacterial gastroenteritis

BMJ 1997; 314 doi: http://dx.doi.org/10.1136/bmj.314.7098.1902 (Published 28 June 1997) Cite this as: BMJ 1997;314:1902

Bowel symptoms vary over time

  1. David Gorard, Consultant gastroenterologista
  1. a Wycombe Hospital, High Wycombe HP11 2TT
  2. b St George's Hospital Medical School, London SW17 ORE
  3. c Mayday University Hospital, Thornton Heath, Surrey CR7 7YE
  4. d Northwich Mental Health Resource Centre, Northwich, Cheshire CW9 7LU
  5. e Department of Old Age Psychiatry, Newcastle General Hospital, Newcastle upon Tyne NE4 6BZ
  6. f Macclesfield District General Hospital, Macclesfield
  7. g University of Nottingham, Nottingham NG7 2UH
  8. h Queens Medical Centre, Nottingham NG7 2UH

    Editor—Keith R Neal and colleagues found that six months after having bacterial gastroenteritis 90 of 386 respondents to a questionnaire had persistent bowel symptoms and 43 fulfilled criteria for the irritable bowel syndrome.1 Of these 43 patients, 23 were deemed to have developed the syndrome since the infection. Most gastroenterologists would agree that altered bowel habit often persists after an infective gastroenteritis. The authors' conclusion that the bacterial gastroenteritis led to this magnitude of persisting bowel dysfunction assumes that accurate data were available about bowel habits before the acute illness. Unfortunately, the retrospective questionnaire study relies on recall of bowel habit six months before the gastroenteritis–that is, one year earlier. This baseline measurement of past bowel habit is likely to be unreliable. Others have shown that abdominal pain and symptoms of the irritable bowel syndrome are often experienced by apparently healthy people and ignored. Such symptoms come to light only when current bowel habit is studied.2 Thus bowel symptoms before the gastroenteritis may have been underreported by some of the patients. This may explain why only 20 (5%) of the patients had pre-existing irritable bowel syndrome, whereas the reported prevalence in Britain is 14-22%.3 4 Answers to questions about current bowel habit at six months are likely to have been more reliable and gave a more comparable prevalence of the irritable bowel syndrome of 11%.

    Repeated measures of the prevalence of symptoms within the same population over time may be confounded by spontaneous turnover of symptoms. In one study 9% of initially asymptomatic subjects developed the irritable bowel syndrome over 12-20 months while a corresponding proportion with the syndrome lost their symptoms.5 Although Neal and colleagues …

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