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Objective: Disorders of gut-brain interaction may arise after acute gastroenteritis. Data on the influence of pathogen type on the risk of postinfection IBS (PI-IBS), as on postinfection functional dyspepsia (PI-FD), are limited. We conducted a systematic review and meta-analysis to determine prevalence of PI-IBS or PI-FD after acute gastroenteritis., Design: We included observational studies recruiting ≥50 adults and reporting prevalence of IBS or FD after acute gastroenteritis with ≥3-month follow-up. A random effects model was used to estimate prevalence and ORs with 95% CIs., Results: In total, 47 studies (28 170 subjects) were eligible. Overall prevalence of PI-IBS and PI-FD were 14.5% and 12.7%, respectively. IBS persisted in 39.8% of subjects in the long-term (>5 years follow-up) after diagnosis. Individuals experiencing acute gastroenteritis had a significantly higher odds of IBS (OR 4.3) and FD (OR 3.0) than non-exposed controls. PI-IBS was most associated with parasites (prevalence 30.1%), but in only two studies, followed by bacteria (18.3%) and viruses (10.7%). In available studies, Campylobacter was associated with the highest PI-IBS prevalence (20.7%) whereas Proteobacteria and SARS-CoV-2 yielded the highest odds for PI-IBS (both OR 5.4). Prevalence of PI-FD was 10.0% for SARS-CoV-2 and 13.6% for bacteria (Enterobacteriaceae 19.4%)., Conclusion: In a large systematic review and meta-analysis, 14.5% of individuals experiencing acute gastroenteritis developed PI-IBS and 12.7% PI-FD, with greater than fourfold increased odds for IBS and threefold for FD. Proinflammatory microbes, including Proteobacteria and subcategories, and SARS-CoV-2, may be associated with the development of PI-IBS and PI-FD., Competing Interests: Competing interests: AG reports personal fees for consultancy for Eisai, 3PSolutions, Real Time Meeting, Fondazione Istituto Danone, Sinergie Board MRGE and Sanofi; personal fees for acting as a speaker for Takeda, AbbVie and Sandoz and personal fees for acting on advisory boards for VSL3 and Eisai. GI has received personal fees for acting as speaker for Alfa Sigma, Biocodex, Illumina, Malesci, Sofar and Tillotts Pharma, and for acting as consultant/advisor for Biocodex, Malesci and Tillots Pharma. The other authors have no potential competing interest to disclose., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Competing interests: RCS has received research grants from Ironwood Pharmaceuticals, Zespri International and Sanofi-Aventis and lecturing fees from Menarini and Alfawasserman.

Introduction The current means of measuring gut motility are limited. Manometry and scintigraphic transit tests are the two most commonly used tests to investigate small bowel motility. Diarrhoeal symptoms are a frequent problem in clinical practise. They can be explained by abnormalities in the absorption and secretion of fluids but also by changes in the motility of the small and large intestine. Methods 20 healthy volunteers and 7 patients with infectious diarrhoea (ID) caused by salmonella spec. underwent motility testing of the small bowel by a high-resolution three-dimensional magnetic detection system called 3D-MAGMA. A new technique that allows the tracking of a magnetic capsule in three-dimensional space with high accuracy in position and orientation by sensors placed above a supine patient. Results The pacemaker frequency in patients with infectious diarrhoea (median: 10.6; min-max: 8.4−11.8; (cpm)) did not differ from that in healthy controls (median: 10.7; min-max: 8.4−12.9). There was a tendency of the capsule in patients with diarrhoeal symptoms to cover a greater distance in the first hour after leaving the stomach (controls: median: 150; min-max: 82−262; ID: median: 175; min-max: 135−315; (cm)). The time proportion of spike-wave activity (>0.2 cm/s) in the duodenum was higher in all participants compared to the jejunum as was the velocity of the capsule in the duodenum. However, while patients with infectious diarrhoea showed an increase of strong spike-wave activity (>0.5 cm/s) in the jejunum compared to the duodenum, strong spike-wave activity was absent in the jejunum of controls. For both groups a negative correlation could be found for the time proportion of spike-wave activity (>0.2 cm/s) and the length of time the capsule spent in the duodenum (controls: rs=−0.95; p<0.0001; ID: rs=−0.91; p=0.004). While this could also be shown in the jejunum for controls the correlation was lost in diarrhoea sufferers (controls: rs=−0.91; p<0.0001; ID: rs=−0.62; p=0.14). Conclusion Abnormalities in small bowel motility play an important part in developing diarrhoeal symptoms in patients with gastroenteritis. Especially the distal small bowel appears to be of importance in the development of symptoms. Small bowel testing with magnetic marker monitoring enhances the understanding of the underlying pathophysiology in these patients. [ABSTRACT FROM PUBLISHER]

Introduction Patients presumed to have infection (CDI) often suffer from persisting diarrhoea despite appropriate antibiotic chemotherapy. This phenomenon may occur in up to 50% of patients admitted to Medicine for the Elderly. We set out to investigate the frequency of prolonged diarrhoea locally and to identify potential associations with age and markers of disease severity. Methods We retrospectively reviewed the medical notes, bedside charts and laboratory results of all adult inpatients with CDI over a three month period. Our predetermined case definition was a clinical diagnosis of CDI (at the time of the illness) plus documented diarrhoea and a positive faecal toxin enzyme immunoassay (EIA). In addition, we obtained the results of faecal culture from an ongoing study of CDI at our institution. Data were analysed using STATA10. Results Seventy-six patients met the case definition, of which 60 (79%) had notes available. Poor documentation in 6 (10%) and discharge with ongoing diarrhoea in 7 (12%) made it impossible to determine the duration of diarrhoea. In the remaining 47 patients (78%), the median duration of diarrhoea was 10 days (IQR, 6–20.5 days). Ten patients (21%) had symptoms for 3 weeks or more. Duration was independent of age (p=0.78) and of clinical and laboratory markers of severity (). Five patients (23%) with diarrhoea persisting beyond the median were culture negative compared with 3 (13%) of those with shorter duration although this difference was not statistically significant (p=0.3). PTU-019 Severity and duration Conclusion In this study, persistence of diarrhoea was common, not limited to the elderly, and often prolonged. This places a significant burden on hospital resources. The origin of the problem is unclear but continued severe inflammation seems unlikely given the distribution of our markers of severity across the two groups. Further, false positive EIA results are well recognised; a total of 15 (25%) of the 60 patients in the study were EIA positive but culture negative. This, together with the difficulty distinguishing colonisation from infection, raises the possibility that other causes of diarrhoea may have been under-diagnosed. [ABSTRACT FROM PUBLISHER]

Background: Shanghai fever, a community-acquired enteric illness associated with sepsis caused by Pseudomonas aeruginosa, was first described in 1918. The understanding of Shanghai fever is incomplete., Objective: To delineate the clinical features and to examine the host and microbial factors associated with Shanghai fever., Methods: We prospectively enrolled 27 consecutive previously healthy children with community-acquired P aeruginosa enteritis and sepsis between July 2003 and June 2012. An immunological investigation, including measurement of serum immunoglobulin levels and lymphocyte subpopulations, was performed. The clonal relationship of bacterial isolates was determined by multilocus sequence typing (MLST) and the virulence of isolates was measured using cellular and animal models., Results: The median age of the patients was 7 months; 24 (89%) were aged <1 year. The most common clinical manifestations were fever (100%), diarrhoea (96%) and shock (81%). Leucopenia, thrombocytopenia, high C-reactive protein levels, coagulopathy and hypoalbuminaemia were the key laboratory findings. Necrotising enteritis with or without bowel perforation, ecthyma gangrenosum and seizures were main complications. The death rate was 15%. No common primary immune deficiency was identified. MLST genotypes indicated that isolates from Shanghai fever were non-clonal, but they shared similar phenotypes which were invariably cytotoxic, invasive and adhesive in cellular experiments and caused prolonged gut colonisation and more death than respiratory and laboratory control strains in mice., Conclusions: Shanghai fever is a sporadic community-acquired disease of previously healthy infants that manifests as sepsis associated with P aeruginosa enteric disease. Both host and microbial factors play a role in pathogenesis.