Irritable bowel syndrome after acute intestinal infection: Aspects of therapy on a clinical example

Irritable bowel syndrome (IBS) is a chronic functional bowel disorder that is common among young and working-age individuals and can significantly impact quality of life. Among the etiopathogenetic aspects of IBS development, the most important are intestinal motility disorders, visceral hypersensitivity, and intestinal microbiome disorders. A previous acute intestinal infection can have a significant impact on the latter, subsequently forming a post-infectious variant of IBS (PI-IBS), the frequency of which depends on what etiological factor led to the development of acute infectious gastroenteritis (bacteria, viruses, protozoa). Risk factors for the development of PI-IBS have been studied and described, among which are the severity of intestinal infection, duration of diarrhea for more than 7 days, female gender, level of anxiety and depression. Approaches to the treatment of PI-IBS have not been developed. It is proposed to use treatment options that are consistent with approaches to non-infectious IBS in accordance with the Rome Consensus IV. The first-line drugs for pain relief are antispasmodics, which reduce the tone and contractility of the smooth muscles of the intestine, effectively coping with abdominal pain. The drug of choice for patients with PI-IBS are calcium channel blockers, namely Otilonium bromide, which is widely used worldwide, is effective and safe, has additional antibacterial and antimycotic properties, is well tolerated and is superior to placebo in reducing symptoms and preventing relapse of pain in patients with IBS. In the therapy of PI-IBS, the use of rifaximin and probiotic preparations for at least 12 weeks is of great importance. This article provides a review of the literature on the prevalence and etiopathogenetic aspects of PI-IBS, as well as possible approaches to the treatment of such patients. A clinical case is presented.