Background: 

Postinfection irritable bowel syndrome (PI-IBS) affects ~14% patients after acute bacterial enterocolitis.

Aim: 

The aim of this study was to conduct a systematic review and meta-analysis to find the prevalence of PI-IBS following Clostridioides difficile infection (CDI).

Methods: 

We systematically searched Medline, Embase, and Web of Science from inception through January 20, 2020 for cohort studies assessing PI-IBS following CDI. Primary outcome was pooled prevalence calculated using inverse variance heterogeneity model [MetaXL (v. 5.3)]. A priori subgroup analyses were done [by irritable bowel syndrome (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 fecal microbiota transplantation vs. antibiotic only]. Heterogeneity was considered substantial if I²>50%.

Results: 

From 2007 to 2019, 15 studies were included (10 prospective, 5 retrospective; 9 full-text, 6 abstracts). Data from 1218 patients were included in the quantitative analysis. Risk of bias was low in 7, medium in 4 and high in 4 studies. Pooled prevalence of PI-IBS was 21.1% (95% confidence interval, 8.2%-35.7%), I²=96%. Common PI-IBS subtypes were diarrhea-predominant in 46.3% (50) patients, and mixed in 33.3% (36) patients. Subgroup analyses by IBS diagnostic criteria, time of IBS diagnosis or CDI treatment did not significantly change the primary outcome (all P>0.05), nor decrease heterogeneity. Funnel plot analysis revealed publication bias.

Conclusions: 

Over 20% of patients develop PI-IBS after CDI. Factors such as diagnostic criteria for IBS and CDI treatment did not affect prevalence, though small numbers limit the confidence in these conclusions. Larger, well conducted studies are needed to study PI-IBS in CDI.

中文翻译：

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艰难梭菌感染后感染后肠易激综合征：系统评价和荟萃分析

背景： 

感染后肠易激综合征 (PI-IBS) 影响约 14% 的急性细菌性小肠结肠炎患者。

目的： 

本研究的目的是进行系统回顾和荟萃分析，以确定艰难梭菌感染 (CDI)后 PI-IBS 的患病率。

方法： 

我们系统地检索了 Medline、Embase 和 Web of Science 从成立到 2020 年 1 月 20 日的评估 CDI 后 PI-IBS 的队列研究。主要结果是使用逆方差异质性模型 [MetaXL (v. 5.3)] 计算的汇总患病率。先验亚组分析[根据肠易激综合征 (IBS) 诊断标准 - 罗马与其他标准、IBS 诊断时间 - <6 或 >6 个月、排除或纳入先前存在的 IBS 和 CDI 治疗 - 抗生素与粪便微生物群移植与仅抗生素]。如果I ² >50%，则认为异质性很大。

结果： 

从 2007 年到 2019 年，纳入了 15 项研究（10 项前瞻性研究，5 项回顾性研究；9 项全文，6 项摘要）。定量分析中纳入了 1218 名患者的数据。7 项研究的偏倚风险为低，4 项研究的偏倚风险为中等，4 项研究的偏倚风险为高。PI-IBS 的汇总患病率为 21.1%（95% 置信区间，8.2%-35.7%），I ² =96%。常见的 PI-IBS 亚型在 46.3%（50 名）患者中以腹泻为主，在 33.3%（36 名）患者中混合型。按 IBS 诊断标准、IBS 诊断时间或 CDI 治疗进行的亚组分析并未显着改变主要结局（均P > 0.05），也未降低异质性。漏斗图分析揭示了发表偏倚。

结论： 

超过 20% 的患者在 CDI 后出现 PI-IBS。IBS 和 CDI 治疗的诊断标准等因素并不影响患病率，尽管数量较少限制了这些结论的可信度。需要更大规模、开展良好的研究来研究 CDI 中的 PI-IBS。