Disorders of gut–brain interaction (DGBI), including irritable bowel syndrome (IBS) and functional dyspepsia (FD), constitute a large proportion of the gastroenterology workload encountered within healthcare settings 1. According to Rome IV Criteria, IBS and FD affect 4.5% and 7.8% of adults globally 2. These conditions significantly impair patients' perceived quality-of-life and healthcare utilisation 2, 3. It has long been shown that multiple biopsychosocial factors influence the occurrence and severity of DGBI 4, 5. Individuals with infectious gastroenteritis have been shown by numerous cohort studies to be at increased risk of developing IBS and FD 6. Post-infective DGBI is an important subgroup, with unique sociodemographic and clinical characteristics, estimated to account for 10.5% of the total burden of DGBI worldwide 7. Previous studies have suggested that the risks of post-infective DGBI are not only influenced by the severity of the infective illness itself, but that the causative microorganism itself is an important aetiological factor, with previously reported associations with Shigella and parasitic infections 8. However, previous studies have either been limited by sample sizes or confined to single regions. In this context, the study by Eldesouki et al. is a welcome addition to the literature, being the largest study of post-infectious enteritis DGBI, spanning the largest geographic area 9. The authors assembled matched cohorts of over 200,000 individuals and quantified the long-term risk of new onset IBS and FD at 1, 5 and 10 years after infectious enteritis. In the infectious enteritis group, IBS and FD risk was found to be consistently elevated across all time points, alongside significantly higher utilisation of DGBI-related medications, abdominal imaging, endoscopy and hospitalisation 9. This provides a granular and compelling picture of the sustained healthcare impact of post-infectious DGBI. Additionally, pathogen-specific analyses revealed a gradient whereby Salmonella/Shigella and Giardia lamblia were associated with the highest subsequent IBS risk, with viral enteritis having the lowest, a pattern in keeping with differences in pathogenic mucosal invasion and disruption, as well as immune activation. Multivariable regression modelling further highlighted obesity and psychological comorbidity as independent predictors, confirming associations described in DGBI in non-infectious settings and underscoring the multifactorial nature of post-infectious DGBI. These findings have important potential clinical implications. Patients recovering from ‘high-risk’ pathogens may benefit from proactive post-infectious follow-up with symptom screening, biopsychosocial assessment, with rapid access to early interventions with targeted integrated multidisciplinary interventions to identify and treat those progressing towards IBS or FD. However, despite the further clarification of long-term infectious enteritis DGBI sequelae provided by Eldesouki et al., important knowledge gaps remain. No studies have evaluated the long-term natural history of post-infectious IBS using consistent diagnostic criteria, validated DGBI-specific patient outcome measures for symptom severity and biopsychosocial variables across multiple time points. Lastly, no study has attempted to assess the temporal overlap between IBS and FD in individuals with post-infective DGBI. These gaps present important opportunities for future prospective, patient-centred research. Such work will be essential if we are to translate these epidemiological insights into preventive and early-intervention strategies for high-risk pathogens and vulnerable individuals. Ayodele Sasegbon: writing – original draft. Dipesh H. Vasant: conceptualization, writing – review and editing. The authors have nothing to report. This article is linked to Eldesouki et al. paper. To view this article, visit https://doi.org/10.1111/apt.70602. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.
Sasegbon et al. (Tue,) studied this question.