Postinfection IBS common after C. difficile infection

A recent systematic review and meta-analysis has found that more than one in five patients develop postinfection irritable bowel syndrome (PI-IBS) following Clostridioides difficile infection (CDI).

The researchers searched the databases of Medline, Embase, and Web of Science from inception through 20 January 2020 for cohort studies assessing PI-IBS after CDI. Pooled prevalence, the primary outcomes, was calculated using inverse variance heterogeneity model.

A priori subgroup analyses were also conducted by IBS diagnostic criteria-Rome vs others, time of IBS diagnosis <6 or >6 mo, exclusion or inclusion of pre-existing IBS, and CDI treatment-antibiotic with faecal microbiota transplantation vs antibiotic only. Heterogeneity was deemed substantial if I² >50 percent.

Fifteen studies (10 prospective, five retrospective; nine full-text, six abstracts) published from 2007 to 2019 met the eligibility criteria. Data from a total of 1,218 patients were included in the quantitative analysis. Risk of bias was low in seven studies, medium in four, and high in four.

PI-IBS had a pooled prevalence of 21.1 percent (95 percent confidence interval, 8.2‒35.7; I², 96 percent). Common PI-IBS subtypes were diarrhoea-predominant in 50 patients (46.3 percent) and mixed in 36 (33.3 percent).

In subgroup analyses by IBS diagnostic criteria, time of IBS diagnosis or CDI treatment neither changed the primary outcome significantly (p>0.05 for all) nor decreased heterogeneity. Of note, publication bias was noted in funnel plot analysis.

“Factors such as diagnostic criteria for IBS and CDI treatment did not affect prevalence, though small numbers limit the confidence in these conclusions,” the researchers said. “Larger, well conducted studies are needed to study PI-IBS in CDI.”