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Post-Infectious Irritable Bowel Syndrome

Irritable Bowel Syndrome (or “IBS”) is one of the more commonly diagnosed gastrointestinal disorders. But within the larger population of those diagnosed with IBS, one significant subgroup suffers the sudden onset of IBS symptoms following an acute case of gastroenteritis, usually caused by such bacteria as salmonella or E. coli, but on occasion appearing after an infection with a parasite like Cyclospora or viral gastroenteritis caused by something like norovirus.[i] The onset of IBS after these food borne illnesses in called post-infectious IBS (PI-IBS). [ii] They are relatively rare, but can significantly impact the lives of one-in-twenty of the victims of food poisoning.

The Health Care Costs of Post-Infectious Irritable Bowel Syndrome

PI-IBS is often missed when people bring a food poisoning claim, and this error can be a costly one.  PI-IBS can be much worse than the initial illness and have life-long consequences. In the U.S. more than $25 billion is spent on managing patients with IBS through direct costs of health care and indirect costs of absenteeism from work.[iii]  Patients with IBS have 3 times the rate of missing work than persons without IBS as they have long periods of disability.[iv]  The level of productivity in patients with IBS averages 35% less compared with people without IBS.[v]

In addition, Patients with IBS make a significantly greater number of healthcare visits each year compared with non-IBS patients.[vi]  A number of studies have looked at the annual cost of care of patients with the diarrhea form of IBS (IBS-D).  In a study of managed care costs, IBS compared with non-IBS controls increased annual medical costs by 49%.[vii]

In fact, Patients with IBS incurred an average direct cost of $5,049 and $406 out of pocket expenses in 2007.[viii]  A more recent study summarizes data from 35 studies of the cost of IBS and found that the direct medical costs for the disease ranged from $1,562 to $7547 per year with indirect costs ranging from $791 to $7,737 per year. [ix]

About Post Infectious Irritable Bowel Syndrome

According to Robin Spiller, MD, Professor of Gastroenterology, PI-IBS was first identified following World War II when soldiers who had developed IBS-like symptoms were returning from the war where they has acquired bacterial dysentery. Since then a great deal of research has focused on IBS and PI-IBS leading to significant findings:

  1. The most common forms of diarrhea leading to PI-IBS are inflammatory bacterial diarrhea, such as food borne bacteria like Salmonella[x] or E. coli that result in chronic intestinal inflammation.
  2. IBS is usually diagnosed based on the symptoms and the Rome criteria for IBS.[xi]
  3. Most PI-IBS victims, prior to the onset of gastrointestinal illness, have a completely negative history of gastrointestinal disease, allowing medical professionals to rule out pre-existent functional bowel disease.
  4. The timing of the initial onset of gastrointestinal illness infection and subsequent IBS is an important factor in its diagnosis, and in  most cases when acute gastrointestinal illness is the cause of PI-IBS, the PI-IBS will develop within six months of that acute illness.

According to most studies, victims of PI-IBS may be symptomatic many years after their initial presentation, with evidence that the median duration for idiopathic IBS patients, and  PI-IBS patients, is greater than 12 years.

What is the Prospect for Recovery in PI-IBS? Medications and Recovery Time

Studies indicate that about 50% of patients with PI-IBS will eventually recover with no specific treatment, though this may take some years. The coexistence of severe untreated anxiety or depression may reduce chances for recovery.  For those who are treated, two of the newer available medications currently approved for treatment include rifaximin and eluxadoline, both being expensive medications.[xii] As an example, IBS therapy with rifaximin usually includes 550 mg three times a day for two weeks or more weeks[xiii] – a total of 42 tablets is needed for two weeks at a wholesale cost of between $1,000 and $2,000.

Studies have also shown that a majority of PI-IBS patients are still affected by IBS at the time point when the follow-up occurred:  5 years[xiv], 6 years [xv]or 8 years 19 [xvi]from their initial presentation. In additionin a large medical clinic population of IBS patients, one study found the median duration for idiopathic IBS patients was 12.7 years, and for PI-IBS patients the median length of time the patients were suffering from IBS was a near identical 12.5 years.[xvii]

For more information about post-infectious IBS, or to speak to a post-infectious IBS lawyer, call 1-888-335-4901.

[i] Cremon C, Stanghellini V, Pallotti F, et al. Salmonella Gastroenteritis During Childhood Is a Risk Factor for Irritable Bowel Syndrome in Adulthood. Gastroenterology 2014.

[ii] Schwille-Kiuntke J, Enck P, Zendler C, et al. Postinfectious irritable bowel syndrome: follow-up of a patient cohort of confirmed cases of bacterial infection with Salmonella or Campylobacter. Neurogastroenterol Motil 2011;23:e479-88.

[iii] Camilleri M. Management of the irritable bowel syndrome. Gastroenterology 2001;120:652-68.

[iv] Drossman DA, Li Z, Andruzzi E, et al. U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci 1993;38:1569-80.

[v] Pare P, Gray J, Lam S, et al. Health-related quality of life, work productivity, and health care resource utilization of subjects with irritable bowel syndrome: baseline results from LOGIC (Longitudinal Outcomes Study of Gastrointestinal Symptoms in Canada), a naturalistic study. Clinical therapeutics 2006;28:1726-35; discussion 10-1..

[vi] Patel RP, Petitta A, Fogel R, Peterson E, Zarowitz BJ. The economic impact of irritable bowel syndrome in a managed care setting. J Clin Gastroenterol 2002;35:14-20.

[vii] Levy RL, Von Korff M, Whitehead WE, et al. Costs of care for irritable bowel syndrome patients in a health maintenance organization. Am J Gastroenterol 2001;96:3122-9.

[viii] Nyrop KA, Palsson OS, Levy RL, et al. Costs of health care for irritable bowel syndrome, chronic constipation, functional diarrhoea and functional abdominal pain. Aliment Pharmacol Ther 2007;26:237-48.

[ix] Nellesen D, Yee K, Chawla A, Lewis BE, Carson RT. A systematic review of the economic and humanistic burden of illness in irritable bowel syndrome and chronic constipation. Journal of managed care pharmacy : JMCP 2013;19:755-64.

[x] Porter CK, Choi D, Cash B, et al. Pathogen-specific risk of chronic gastrointestinal disorders following bacterial causes of foodborne illness. BMC Gastroenterol 2013;13:46.

[xi] Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology 2006;130:1480-91;  see also www.romecriteria.org/criteria.

[xii] Cash BD, Lacy BE, Rao T, Earnest DL. Rifaximin and eluxadoline – newly approved treatments for diarrhea-predominant irritable bowel syndrome: what is their role in clinical practice alongside alosetron? Expert opinion on pharmacotherapy 2015:1-12.

[xiii] Pimentel M, Lembo A, Chey WD, et al. Rifaximin therapy for patients with irritable bowel syndrome without constipation. N Engl J Med 2011;364:22-32.

[xiv] Tornblom H, Holmvall P, Svenungsson B, Lindberg G. Gastrointestinal symptoms after infectious diarrhea: a five-year follow-up in a Swedish cohort of adults. Clin Gastroenterol Hepatol 2007;5:461-4.

[xv] Neal KR, Barker L, Spiller RC. Prognosis in post-infective irritable bowel syndrome: a six year follow up study. Gut 2002;51:410-3

[xvi] 19.  Marshall JK, Thabane M, Garg AX, Clark WF, Moayyedi P, Collins SM. Eight year prognosis of postinfectious irritable bowel syndrome following waterborne bacterial dysentery. Gut 2010;59:605-11.

[xvii] DuPont HL, Galler G, Garcia-Torres F, DuPont AW, Greisinger A, Jiang ZD. Travel and travelers’ diarrhea in patients with irritable bowel syndrome. Am J Trop Med Hyg 2010;82:301-5.

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