Irritable Bowel Syndrome Among a Cohort of European Travelers to Resource-Limited Destinations

Background. Travelers' diarrhea (TD) remains a frequent travel-associated infection. Between 4 and 32% of enteric infections were followed by a postinfectious irritable bowel syndrome (pIBS) with long-term sequelae in various settings. Travel-related IBS incidence rates are based on small studies and IBS predictors have not been sufficiently evaluated. Methods. Adult travelers to resource-limited destinations participated in a prospective questionnaire-based cohort study. Demographics, travel characteristics, and medical history were assessed and those with functional or organic gastrointestinal disorders were excluded. Immediately after return from abroad, the volunteers completed a second questionnaire on TD, other health impairments, and on nutritional hygiene. Six-months post-travel, a follow-up questionnaire assessed IBS based on Rome III criteria. Risk factors were analyzed by multiple logistic regression. Results. Among a total of 2,476 subjects analyzed (participation rate 72.4%), 38 (1.5%) developed new IBS, and the 6-month incidence rate for pIBS was 3.0% (95% CI 1.9-4.2) following TD. Significant risk factors were TD during the surveyed journey (OR 3.7; 95% 1.8-7.4), an adverse life event experienced within 12 months pre-travel (OR 3.1; 1.4-6.8), and a diarrheal episode experienced within 4 months pre-travel (OR 2.7; 95% CI 1.3-5.6). Following multiple diarrheal episodes, the risk of acquiring IBS increased by six times. Conclusions. In a large population of European travelers IBS had a lower incidence rate as compared to previous studies. Particular risk groups were identified; those may need to be protected.