SNFGE SNFGE
 
Thématique :
- Intestin/Nutrition/Troubles fonctionnels
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Docteur Pauline JOUET
Coup de coeur :
 
 
Gastroenterology
  2017/04  
 
  2017 Apr;152(5):1042-1054.e1.  
  doi: 10.1053/j.gastro.2016.12.039.  
 
  Prevalence, Risk Factors, and Outcomes of Irritable Bowel Syndrome After Infectious Enteritis: A Systematic Review and Meta-analysis.  
 
  Klem F, Wadhwa A, Prokop LJ, Sundt WJ, Farrugia G, Camilleri M, Singh S, Grover M  
  https://www.ncbi.nlm.nih.gov/pubmed/28069350  
 
 

Abstract

BACKGROUND & AIMS:

Foodborne illness affects 15% of the US population each year, and is a risk factor for irritable bowel syndrome (IBS). We evaluated risk of, risk factors for, and outcomes of IBS after infectious enteritis.

METHODS:

We performed a systematic review of electronic databases from 1994 through August 31, 2015 to identify cohort studies of the prevalence of IBS 3 months or more after infectious enteritis. We used random-effects meta-analysis to calculate the summary point prevalence of IBS after infectious enteritis, as well as relative risk (compared with individuals without infectious enteritis) and host- and enteritis-related risk factors.

RESULTS:

We identified 45 studies, comprising 21,421 individuals with enteritis, followed for 3 months to 10 years for development of IBS. The pooled prevalence of IBS at 12 months after infectious enteritis was 10.1% (95% confidence interval [CI], 7.2-14.1) and at more than 12 months after infectious enteritis was 14.5% (95% CI, 7.7-25.5). Risk of IBS was 4.2-fold higher in patients who had infectious enteritis in the past 12 months than in those who had not (95% CI, 3.1-5.7); risk of IBS was 2.3-fold higher in individuals who had infectious enteritis more than 12 months ago than in individuals who had not (95% CI, 1.8-3.0). Of patients with enteritis caused by protozoa or parasites, 41.9% developed IBS, and of patients with enteritis caused by bacterial infection, 13.8% developed IBS. Risk of IBS was significantly increased in women (odds ratio [OR], 2.2; 95% CI, 1.6-3.1) and individuals with antibiotic exposure (OR, 1.7; 95% CI, 1.2-2.4), anxiety (OR, 2; 95% CI, 1.3-2.9), depression (OR, 1.5; 95% CI, 1.2-1.9), somatization (OR, 4.1; 95% CI, 2.7-6.0), neuroticism (OR, 3.3; 95% CI, 1.6-6.5), and clinical indicators of enteritis severity. There was a considerable level of heterogeneity among studies.

CONCLUSIONS:

In a systematic review and meta-analysis, we found >10% of patients with infectious enteritis develop IBS later; risk of IBS was 4-fold higher than in individuals who did not have infectious enteritis, although there was heterogeneity among studies analyzed. Women-particularly those with severe enteritis-are at increased risk for developing IBS, as are individuals with psychological distress and users of antibiotics during the enteritis.

 
Question posée
 
Quelle est la prévalence du SII post-infectieux et quels sont les facteurs de risque ?
 
Question posée
 
Dans cette revue systématique avec méta-analyse portant sur 45 études et plus de 20 000 patients ayant fait un épisode de gastroentérite aiguë, 10,1% présentaient un SII dans les 12 mois suivant l’épisode, avec un risque de SII 4,2 fois plus fréquent. Elle confirme l’influence du terrain (plus fréquent chez les femmes, sur un terrain anxio-dépressif), et du type d’épisode (plus fréquent en cas d’épisode sévère et/ou de prise d’antibiotiques, en cas d’infection parasitaire ou bactérienne).
 
Commentaires

Cette étude sur un grand nombre de patients confirme ce que l’on savait déjà, même si E. Quigley, dans son éditorial, note qu’avec de tels résultats au vue de la prévalence des gastroentérites aigues aux USA, l’infection devrait être la cause prédominante de SII, ce qui n’est pas le cas en pratique clinique…

 
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