PI-IBS Common Following Clostridioides difficile Infection

About 21% of patients with Clostridioides difficile infection (CDI) will develop postinfectious irritable bowel syndrome (PI-IBS), according to a study in the Journal of Clinical Gastroenterology.

Researchers conducted a systematic review and meta-analysis to estimate the prevalence of PI-IBS following CDI and determine the effects of patient and disease-related factors on that prevalence. They performed a comprehensive literature search using multiple databases from inception through January 20, 2020, for relevant studies.

The primary outcome was pooled prevalence of PI-IBS after CDI. A total of 15 studies published from 2007 to 2019 were included in the review — 10 were prospective cohort studies and 5 were retrospective cohort studies. Data from 1218 patients were included in the final quantitative analysis.

Among the 13 studies included in the quantitative synthesis, the prevalence of PI-IBS ranged from 1.5% to 84.5%. The pooled prevalence was 21.1% (95% CI, 8.2%-35.7%; I2=96%). After exclusion of an outlier study, the pooled prevalence was 17.0% (95% CI, 9.2%-25.6%; I2=88%), though the difference was not statistically significant (P =.62).

After exclusion of studies with a medium or high risk of bias, the pooled prevalence was 16.8% (95% CI, 9.0%-25.5%; I2=80%). In an analysis that excluded studies that were published as conference abstracts only, the pooled prevalence was 20.1% (95% CI, 3.7%-40.0%; I2=97%).

IBS subtypes were reported in 5 studies (108 patients with PI-IBS): IBS-diarrhea was predominant in 46.3% (50), IBS-mixed predominant in 33.3% (36), IBS-constipation predominant in 17.6% (19), and unknown in 2.8% (3) patients.

As substantial heterogeneity was present in the primary outcome, the study authors conducted several a priori specified subgroup analyses. These analyses, according to IBS diagnostic criteria (Rome or not), time of diagnosis, exclusion or not of pre-existing IBS patients, and CDI treatment modality, showed no statistically significant differences in pooled prevalence between the groups.

In addition to the substantial heterogeneity in the primary outcome, not all studies used the Rome criteria. Details were limited regarding the CDI episode, associated symptomatology, and past CDI history, and only 1 study included a control group.

“Our study highlights several gaps in this field, such as the limited data on various risk factors affecting PI-IBS and lack of information on natural history of PI-IBS,” stated the researchers. “Well-conducted larger studies are mandated to further study these aspects.”


Saha S, Sehgal K, Singh S, Grover M, Pardi D, Khanna S. Postinfection irritable bowel syndrome following Clostridioides difficile infection: a systematic-review and meta-analysis. J Clin Gastroenterol. 2022;56(2):e84-e93. doi: 10.1097/MCG.0000000000001536