Changes in anorectal function in persistent bowel disturbance following salmonella gastroenteritis

OBJECTIVETo study the symptoms and anorectal function of eight patients with persistent bowel disturbance following gastroenteritis and to compare the results with those of matched groups of normal volunteers and patients with diarrhoea-predominant irritable bowel syndrome. METHODSOut of a total of 38 people who contracted salmonella gastroenteritis in two well documented outbreaks, 12 (32%) continued to suffer from persistent bowel disturbance 2 years after the original infection. None had symptoms of irritable bowel syndrome prior to the infection. All had negative stool cultures at the time of these tests. Eight of these patients (seven women and one man; aged 28–71 years) agreed to undergo further investigation. Anorectal manometry and rectal sensitivity were recorded using a water perfused multilumen catheter with an attached balloon which was rapidly inflated with air at increasing volumes. RESULTSAll subjects showed increased rectal sensitivity and decreased rectal compliance compared with a group of normal controls. In addition, there were significant decreases in the rectal volumes required to induce relaxation of the internal anal sphincter and repetitive rectal contractions. Both the symptoms and the abnormalities in anorectal physiology were identical to those observed in patients with a subset of irritable bowel syndrome. CONCLUSIONThese results support the hypothesis that a prior attack of gastroenteritis can induce irritable bowel syndrome in a susceptible group of people.