28th February 2024
Contents
Symptoms and Frequency of Post infectious IBS
What is IBS?
Why does IBS develop post food poisoning?
Does post-infectious IBS ever go away?
How long will it take to recover from post-infectious IBS?
Sylvie’s story of post-infectious IBS and how she cured it
Post infectious IBS and SIBO
What is SIBO?
How to test for SIBO?
Treatment for post -infectious iBS
What is the treatment for post-Infectious IBS if I have SIBO?
Foods to avoid with post-infectious IBS
Probiotics for post infectious IBS
Medications for PI-IBS
Stress Management
Key Takeaways
Post Infectious IBS
Have you ever experienced a nasty bout of food poisoning or a gastrointestinal infection, only to find yourself grappling with ongoing digestive issues long after the infection has cleared? You might be experiencing what’s known as post-infectious irritable bowel syndrome (PI-IBS), a significant consequence of certain gut infections.
Research indicates that one in eleven people who experience food poisoning may go on to develop post- infectious IBS.
If you have ever had Norovirus or Rotavirus or bacteria like Campylobacter or Salmonella, and parasites like Giardia you may be susceptible to developing post-infectious IBS.
Unfortunately even after the infection subsides, for many patients, the ordeal doesn’t end there.
The symptoms of a gastrointestinal infection linger on, manifesting as abdominal pain, bloating, diarrhea, or constipation, resembling those of irritable bowel syndrome (IBS).
What are the Symptoms of Post-infection irritable bowel syndrome (IBS)?
- Abdominal pain or discomfort, often relieved after bowel movements.
- Altered bowel habits, such as diarrhea, constipation, or alternating between the two.
- Bloating or gas.
- Urgency to have bowel movements.
- Difficulty tolerating certain foods such as milk, onions, garlic
- Mucus in the stool.
- Feeling of incomplete bowel evacuation.
- Fatigue.
- Nausea.
- Difficulty sleeping.
- Anxiety or depression.
What is IBS?
IBS stands for Irritable Bowel Syndrome. It’s a common disorder that affects the large intestine (colon) and causes symptoms like abdominal pain, bloating, gas, diarrhea, and constipation.
While the exact cause of IBS is unknown, it’s believed to involve a combination of factors including abnormal muscle contractions in the intestine, increased sensitivity to certain foods, stress, and inflammation in the intestines.
It’s a chronic condition that requires management through lifestyle changes, dietary adjustments, and sometimes medication to control symptoms.
Why does IBS develop post food poisoning?
There are several reasons why you may develop IBS after food poisoning or a tummy bug.
When harmful bacteria, viruses, or other microorganisms enter the gut, the immune system identifies them as foreign threats and launches an inflammatory response to eradicate them.
It’s like your body’s natural shield against invaders. Your immune system sends out signals called cytokines to call in more soldiers (immune cells) to help fight off the germs. These cells work together to combat and neutralize the pathogens.
While inflammation is a crucial defence mechanism, excessive or prolonged inflammation can lead to tissue damage and contribute to the development of gastrointestinal disorders such as irritable bowel syndrome (IBS) which can lead to abdominal pain and discomfort.
Changes in composition of your gut Microbiome:
Your gut is home to trillions of bacteria, crucial for digestion and overall health. But a severe infection can throw this delicate ecosystem out of balance, leading to dysbiosis. Changes in the gut microbiota can influence gut function, potentially contributing to the development of IBS symptoms.
Changes in Gut Motility and Sensation:
The infection can throw off the intricate choreography of gut movements and sensations. This disruption can result in symptoms like diarrhea, constipation, and abdominal pain – hallmarks of IBS.
Immune System Activation:
Have you heard of cytolethal toxin? It’s a harmful substance made by certain bacteria, like Campylobacter jejuni. This toxin can cause damage to cells and tissues in the gastrointestinal tract, leading to symptoms such as diarrhea, abdominal pain, and fever.
Now, let’s talk about vinculin. This protein plays a role in keeping your gut working smoothly.
Here’s the connection: Campylobacter bacteria produce a toxin called cytolethal toxin, which looks a lot like vinculin, a protein naturally found in your body. When your immune system kicks into gear to fight off a Campylobacter infection, it can get confused and start targeting both the bacterial toxin and your own vinculin.
In simple terms, when your immune system goes after the bad bacteria, it might accidentally attack a good guy, causing gut troubles down the line.
Does post-infectious IBS ever go away?
Thankfully for many people symptoms will resolve or improve significantly over time.
Research, Source Pub Med indicates that after one year nearly 20% of patients with recover fully.
Women do not appear to recover as fully as men! Unfortunately for many symptoms may persist for years to come.
The key is understanding what the initial trigger was. The approach we take in our clinic is to try and get to the bottom of your symptoms, understand the root cause and what the initial trigger was.
If this is identified you will have a faster route to recovery.
Do you have a parasitic infection because of a meal you ate?
If so antibiotic treatment will be required.
Have you developed Small Intestinal Bacterial Overgrowth because of issues with motility?
If SIBO is the cause of your symptoms, you may find that following a Low Fodmap diet and taking anti-bacterials may help, at least on the short term.
Are you symptoms due to long- Covid?
How long will it take to recover from post-infectious IBS?
The duration of recovery from post-infectious irritable bowel syndrome (PI-IBS) can vary greatly from person to person. In some cases, symptoms may resolve within a few weeks to months after the initial infection, while in others, symptoms may persist for a longer period, even years.
Factors that can influence the duration of recovery include:
- The severity of the initial infection that triggers the onset of PI-IBS can significantly impact the duration of recuperation. A more intense infection is likely to result in more pronounced and extended symptoms.
- Variations among individuals play a crucial role in how the body responds to infections and the subsequent development of PI-IBS. While some individuals may recover swiftly, others might endure prolonged symptoms.
- The effectiveness of treatments aimed at managing PI-IBS symptoms can also influence the time it takes to recover. Dietary adjustments, antibiotic medications, stress management techniques, and lifestyle changes may offer relief to some individuals.
- The presence of underlying causes can complicate the recovery process from PI-IBS and potentially extend the duration of symptoms. If symptoms persist, undergoing parasite testing and SIBO testing could prove beneficial.
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It’s essential for individuals experiencing PI-IBS symptoms to work closely with their healthcare provider to develop a personalized treatment plan and to monitor their progress. Additionally, adopting a healthy lifestyle, managing stress, and avoiding triggers can help support recovery from PI-IBS.
Sylvie’s story of post-infectious IBS and how she cured it
Sylvie had been on holiday in Italy and picked up a nasty bout of food poisoning on her half-term break from school.
She returned to the UK and was told that her symptoms would resolve in time.
However she continued to experience urgency and cramping for weeks to come.
Unfortunately her symptoms persisted and she ended up seeing a private nutritionist who recommended she follow a Low-Fodmap diet.
Thankfully by following this diet she found that her symptoms were alleviated temporarily and gradually went back to her previous diet reintroducing gluten, dairy and fermentable foods successfully.
After eight months, Sylvie noticed that her symptoms began to return and she had to go back on the Low-Fodmap diet to avoid diarrhea, nausea and cramping. Sylvie contacted our IBS clinic and conducted a SIBO test and discovered that a bacterial overgrowth was present.
She was prescribed some herbal anti-bacterials for 4 weeks that significantly reduced her symptoms.
Post infectious IBS and SIBO
Post-infectious irritable bowel syndrome (IBS) is sometimes associated with a condition known as small intestinal bacterial overgrowth (SIBO), although the precise relationship between the two remains somewhat unclear and may vary from person to person.
In their book, The Microbiome Connection, Dr.Pimentel and Dr. Rezaie explain that Up to 70% of patients who have IBS may have SIBO as an underlying cause.
SIBO can stem from various factors, with food poisoning being a predominant trigger. Anything that disrupts the normal motility of the intestines can lead to SIBO, and food poisoning, in particular, is a common culprit. The slowing down of the small intestine, a consequence of food poisoning, can significantly contribute to the development of SIBO.
Following a gastrointestinal infection, such as gastroenteritis, the balance of bacteria in the gut can be disrupted, potentially leading to the development of post-infectious IBS. In some cases, this disruption may contribute to the onset of SIBO. However, it’s important to recognize that not everyone who experiences post-infectious IBS will develop SIBO, and vice versa.
What is SIBO?
SIBO occurs when there is an overgrowth of bacteria in the small intestine, which can cause symptoms such as bloating, gas, diarrhea, and abdominal pain. While the exact causes of SIBO can be complex and multifaceted, they may include factors such as anatomical abnormalities, impaired gut motility, and alterations in the gut microbiome.
If you suspect that you may be experiencing post-infectious IBS or SIBO, we recommend conducting a SIBO test.
It is essential to consult with a healthcare professional for proper evaluation, diagnosis, and management. Treatment options may include dietary changes, antibiotic therapy, probiotics, and other interventions aimed at alleviating symptoms and restoring gut health. Book a consultation today at our IBS clinic.
How can I test for SIBO?
The most common method for diagnosing SIBO is a breath test and involves drinking a solution containing a sugar substance like lactulose or glucose. Bacteria in the small intestine ferment the sugar, producing gases such as hydrogen and methane. These gases are absorbed into the bloodstream and eventually exhaled through the lungs. By measuring the levels of hydrogen and methane in your breath at specific intervals after drinking the solution, it is possible to assess whether there’s an overgrowth of bacteria in your small intestine.
How do you cure post-infectious IBS?
The key to finding a cure for post-infectious IBS is to unravel the underlying factors that may be contributing to the condition.
If a parasite such as Giardia is the cause, we recommend testing for parasites and receiving treatment from your GP.
If Small intestinal Bacterial Overgrowth is the cause, we recommend testing for SIBO and receiving treatment from a Gastroenterologist who specialises in SIBO or a IBS specialist
In some cases you will need to change your diet to avoid triggers such as diary, gluten and coffee.
What is the treatment for post-Infectious IBS if I have SIBO?
The treatment approach for post-infectious irritable bowel syndrome (IBS) with small intestinal bacterial overgrowth (SIBO) typically involves addressing both conditions simultaneously.
Antibiotics/Herbal Antibiotics for SIBO:
Antibiotics are commonly prescribed to target the bacterial overgrowth in the small intestine. Rifaximin is often the first choice due to its effectiveness and minimal systemic absorption, which reduces the risk of adverse effects.
Typically Rifaximin is taken for two weeks. You will need to find a Gastroenterologist to prescribe Rifaximin as it is unlikely that your GP will prescribe it.
Hopefully symptoms will improve after the initial two-week treatment. However in about 1/3 of patients symptoms may return and you will need to have another round of treatment.
Generally speaking Rifaximin is well tolerated but can be very expensive and difficult to get hold of. Other antibiotics, such as metronidazole or neomycin, may also be considered in certain cases.
Oregano oil for SIBO
If you are struggling to get hold of pharmaceutical antibiotics, herbal antibiotics such as oregano can be equally effective in eradicating the bacterial overgrowth and very easy to get hold of as you can purchase these in any health food store. However do make sure you consult with an IBS specialist as if there may be interactions with your medication and ensure you are not over-dosing. Clinically we have had brilliant results using Oregano for patients who have Hydrogen dominant SIBO.
Probiotics:
Probiotics are beneficial bacteria that can help restore the balance of gut flora. They may be recommended alongside antibiotics or as a maintenance therapy after antibiotic treatment. Lactobacillus and Bifidobacterium strains are among those commonly used for managing SIBO and IBS symptoms. However some patients with SIBO do not tolerate them well.
Dietary modifications: Certain dietary changes can help manage symptoms associated with both SIBO and IBS. A low FODMAP diet is often recommended to reduce symptoms such as bloating, gas, and diarrhea. This diet restricts certain carbohydrates that may exacerbate bacterial fermentation in the gut.
Prokinetics: Prokinetic medications can help improve gastrointestinal motility, which may aid in reducing bacterial overgrowth and alleviating symptoms. Medications like low-dose erythromycin or prucalopride are examples of prokinetics that may be prescribed by healthcare providers. We often use Ginger supplements.
Symptomatic relief: Depending on the predominant symptoms, medications such as antispasmodics for abdominal pain or anti-diarrheal agents for diarrhea may be recommended to provide symptomatic relief.
Lifestyle modifications: Stress management techniques, regular exercise, and adequate sleep can help improve overall gut health and reduce symptom severity.
Elemental diet- In severe cases of SIBO, an elemental diet may be recommended. This involves consuming easily digestible nutrients in liquid form to help reduce bacterial fermentation in the small intestine.
The primary component of an elemental diet is an elemental formula, which contains pre-digested nutrients in a form that requires minimal digestion. These formulas typically consist of amino acids, simple carbohydrates, fats, vitamins, and minerals. They are available in powder form and can be mixed with water to create a liquid meal replacement.
It’s important to note that treatment plans should be individualized based on the specific needs and preferences of each patient. Do contact our IBS clinic so we can help tailor a comprehensive treatment approach for post-infectious IBS with SIBO.
Foods to avoid with post-infectious IBS
Many patients find an improvement in their symptoms relief by adjusting their diet.
This may involve avoiding trigger foods such as caffeine, spicy foods, fatty foods, and alcohol. Some patients improve by adhering to a low-FODMAP diet, which restricts highly fermentable carbohydrates.
A low FODMAP diet is a dietary approach designed to manage symptoms of irritable bowel syndrome (IBS) and other gastrointestinal conditions by reducing intake of certain types of carbohydrates known as FODMAPs, which stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. These carbohydrates can be poorly absorbed in the small intestine and may ferment in the colon, leading to symptoms such as gas, bloating, abdominal pain, diarrhea, and constipation in individuals with sensitive guts. Here’s a breakdown of a low FODMAP diet:
- FODMAP Foods to Limit or Avoid:
- Oligosaccharides: Found in foods like wheat, rye, onions, garlic, legumes (such as lentils, chickpeas, and beans), and some fruits and vegetables like cauliflower and asparagus.
- Disaccharides: Lactose-containing foods such as milk, yogurt, and soft cheeses.
- Monosaccharides: Foods high in excess fructose, such as certain fruits like apples, pears, and mangoes, as well as honey and agave nectar.
- Polyols: Found in certain fruits like stone fruits (such as peaches, plums, and cherries), some vegetables like cauliflower and mushrooms, as well as artificial sweeteners like sorbitol, mannitol, xylitol, and maltitol.
- Low FODMAP Foods to Emphasize:
- Proteins: Meat, poultry, fish, eggs, tofu, and tempeh.
- Grains: Rice, oats, quinoa, and gluten-free products.
- Fruits: Small portions of low FODMAP fruits like berries, citrus fruits (e.g., oranges, lemons), bananas, and grapes.
- Vegetables: Low FODMAP options such as spinach, carrots, cucumbers, tomatoes, bell peppers, and zucchini.
- Dairy Alternatives: Lactose-free milk, lactose-free yogurt, and hard cheeses (which are lower in lactose).
- Portion Control and Moderation: Even low FODMAP foods can trigger symptoms if consumed in large amounts. Portion sizes should be managed, and meals should be balanced to ensure adequate nutrition.
- Gradual Reintroduction: Following a period of strict low FODMAP diet, foods are gradually reintroduced one at a time to identify individual tolerance levels and trigger foods. This step is usually done under the guidance of a registered dietitian.
- Personalization: The low FODMAP diet is not one-size-fits-all. It should be personalized based on individual tolerance levels, symptom severity, and nutritional needs. Book a consultation with our IBS clinic if your are looking for guidance and support.
It’s essential to note that the low FODMAP diet is a short-term intervention meant to identify trigger foods. It’s important to address overall dietary balance and ensure nutritional adequacy while following this diet.
Probiotics for post infectious IBS
Probiotics are beneficial bacteria that can help restore balance to the gut microbiota. Some studies suggest that certain strains of probiotics may be helpful in reducing symptoms of IBS, including those associated with diarrhea and urgency. A good choice for some patients is Saccharomyces Boulaardi Source Pubmed
Saccharomyces boardie has significantly reduced the duration of diarrhea of acute infectious diarrhea. Source Pubmed
Medications for PI-IBS
Your GP may recommend Imodium or other anti-diarrheal medications for diarrhea-predominant symptoms, or laxatives for constipation-predominant symptoms. However these are rarely the solution.
Stress Management
Stress can aggravate symptoms of IBS. Deep breathing exercises, yoga, or cognitive-behavioural therapy (CBT) can help manage stress and improve symptoms.
Key Takeaways:
- Post-Infectious IBS (PI-IBS): PI-IBS can develop after a severe gastrointestinal infection such as food poisoning, leading to ongoing digestive issues even after the infection clears.
- Triggers: Common triggers for PI-IBS include pathogens like Norovirus, Rotavirus, Campylobacter, Salmonella, and parasites like Giardia.
- Underlying Causes: PI-IBS can result from various factors, including inflammation, changes in gut microbiome composition, alterations in gut motility, and immune system activation.
- Symptoms: Symptoms of PI-IBS often resemble those of irritable bowel syndrome (IBS), including abdominal pain, bloating, diarrhea, or constipation.
- Recovery: Recovery from PI-IBS varies from person to person and depends on factors such as the severity of the initial infection, individual differences, treatment effectiveness, and underlying causes.
- Testing: You may wish to consider tests such as SIBO testing, and parasite testing to identify underlying causes.
- Treatment: Treatment strategies for PI-IBS may include dietary changes (such as low FODMAP diet), medication, probiotics, stress management techniques, and addressing underlying conditions like SIBO or parasitic infections.
- Testing for SIBO: The most common method for diagnosing SIBO is a breath test, which measures hydrogen and methane levels in the breath after consuming a sugar solution.
- Probiotics: Probiotics, such as Saccharomyces boulardii, may help restore gut balance and alleviate symptoms of PI-IBS.
- Medications and Stress Management: Medications like Imodium may provide temporary relief, stress management techniques like deep breathing exercises or cognitive-behavioural therapy (CBT) may also be of help.
Book an appointment
If you require help with diet and tests and supplements to alleviate symptoms feel free to contact our IBS clinic
