It’s been two months since Ericka Ratliff, 55, fell ill with cyclospora, yet she is still dealing with sharp abdominal pains and sudden urges to go to the bathroom. “It’s very unpredictable,” she said, as if “my stomach is just extremely angry.”
Ms. Ratliff, who lives in Adrian, Mich., has tried following a bland diet and eating small, frequent meals to quell her symptoms, but she said she worried that her gut would “never be the same again.”
Research suggests that roughly 10 to 20 percent of people who get intestinal illnesses from bacteria, viruses or parasites will end up having symptoms, like diarrhea and abdominal pain, that can last for months or even years. This condition is called post-infection irritable bowel syndrome.
It’s too soon to know whether Ms. Ratliff is dealing with post-infection I.B.S. But after the recent surge in cyclospora infections in the United States, along with other food-borne illness outbreaks linked to jalapeños, sprouts, frozen blueberries and more, some gastroenterologists worry that they may soon be seeing more patients with the condition.
“I’m expecting our clinics to be getting inundated,” said Dr. Baha Moshiree, a gastroenterologist and professor of medicine at Wake Forest University School of Medicine in North Carolina.
What is post-infection I.B.S.?
Post-infection I.B.S. is a subtype of I.B.S. It causes recurrent abdominal pain or discomfort (such as from bloating or gas), along with diarrhea, constipation or both following an acute gut infection. The symptoms — which tend toward diarrhea — often leave people feeling like they never fully recovered from their initial infection, said Dr. William D. Chey, chief of the gastroenterology and hepatology division at Michigan Medicine.
Lewis, 33, an interior decorator in Britain, said he developed food poisoning after eating a sandwich in 2018. (He requested to be identified only by his first name to protect his privacy.)
The initial symptoms of the infection passed after a few days, he said, but today, he is still dealing with sudden diarrhea, abdominal pain, nausea, acid reflux and fatigue, three to four days a week. He was diagnosed with post-infection I.B.S. “Eight years later, my confidence to go out for a long day is low,” Lewis said.
In a study published in 2024, researchers found that among nearly 3,600 people who had norovirus, the coronavirus or other viruses that can infect the gut, 11 percent developed post-infection I.B.S. The scientists also found that 18 percent of about 7,000 infected with bacteria like campylobacter and salmonella went on to develop post-infection I.B.S., and 30 percent of nearly 800 infected with parasites like giardia and trichinella developed the condition.
“Garden variety” I.B.S. is often a chronic, lifelong, condition, Dr. Chey said. Research suggests, however, that post-infection I.B.S. resolves in about half of cases within one to four years.
Scientists don’t know how common post-infection I.B.S. is after an infection with cyclospora, in part because it hasn’t been well-studied, Dr. Chey said. Doctors in Wisconsin published what they believed to be the first documented case in 2023, involving a 65-year-old woman with loose stools, urgency and abdominal cramping more than eight months after a cyclospora infection.
As with regular I.B.S., there is no standard test for post-infection I.B.S. To receive a diagnosis, a patient’s symptoms must have begun at least six months prior. Because of that, it’s not yet clear how many people involved in the recent cyclospora outbreak will develop it, said Dr. Madhusudan Grover, a gastroenterologist and a professor of medicine at Mayo Clinic in Rochester, Minn.
How do gut infections cause I.B.S.?
Scientists haven’t figured out exactly how intestinal infections may cause new I.B.S. symptoms.
One hypothesis is that those infections can damage the lining of the intestines, leading to a “leaky” gut that can allow food molecules, microbes and other gut contents to escape, Dr. Chey said. That leakiness may then activate immune cells and nerves in the intestinal wall in ways that cause pain and diarrhea, he said.
Research suggests that gut infections may also cause the nerves that line the intestines to become extra sensitive, so that they are more likely to perceive normal gas buildup or food moving through the gut as painful.
Another theory is that disruptions to the gut microbiome may contribute to symptoms, in part by depleting the numbers of “good” bacteria that normally help keep the gut lining healthy, Dr. Grover said.
Some bacteria like campylobacter, salmonella and E. coli produce a toxin that causes immune cells in the intestines to make antibodies against it, said Dr. Mark Pimentel, a gastroenterologist and professor of medicine at Cedars Sinai in Los Angeles. Those antibodies may attack the nerves that control contractions in the gut, leading to symptoms like diarrhea, pain and bloating, he said.
What should you do if you have chronic symptoms?
Hannah, 30, an I.T. manager in British Columbia, got an E. coli infection after eating spinach in the United States when she was 14. For about the next six years, she was plagued by severe diarrhea, “maybe 20 bowel movements a day,” she said. She was underweight, fatigued and socially isolated through her first few years of college because of her symptoms. “It was just a period of hell,” said Hannah, who requested to be identified by only her first name to protect her privacy.
When she was about 20, she said, a gastroenterologist diagnosed her with post-infection I.B.S.
If you have lingering symptoms like abdominal pain and diarrhea six months after an intestinal illness, see a gastroenterologist, Dr. Pimentel said. Your doctor may want to rule out whether you still have an active infection (cyclospora, for instance, is difficult to get rid of), or if you have a different condition, like inflammatory bowel disease.
Gut infections can also cause short-term or chronic lactose intolerance, which can mimic I.B.S. symptoms, Dr. Grover said.
There is no cure for post-infection I.B.S., but there are ways to manage the symptoms, Dr. Chey said. Imodium is available over the counter and can alleviate diarrhea; peppermint oil supplements can also reduce pain, cramping and bloating, he said.
Prescription medications include the antibiotic rifaximin, which may help restore the microbiome; tricyclic antidepressants that can target receptors in the gut and brain to reduce pain and diarrhea; and medications that can slow bowel movements, like alosetron and eluxadoline, Dr. Moshiree said.
For Hannah, the tricyclic antidepressant nortriptyline has helped manage her symptoms, she said, adding, “It has given me my life back.”
Certain changes to your diet may also reduce I.B.S. symptoms. The Mediterranean diet, for example, may support the microbiome in a way that improves digestion and reduces symptoms. A low-FODMAP diet involves temporarily avoiding foods that are high in difficult-to-digest sugars, including certain fruits, vegetables, dairy products and legumes, though because the diet is restrictive, it’s best to try it under a dietitian’s guidance, Dr. Moshiree said.
With time, many patients will get better, she added. For those who don’t, there are ways to manage the symptoms. “You don’t have to suffer,” Dr. Moshiree said.
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