FROM INFECTION TO DYSBIOSIS: PATHOGENESIS OF POST-INFECTIOUS IRRITABLE BOWEL SYNDROME - DIAGNOSTIC AND THERAPEUTIC IMPLICATIONS

Aleksander Gajkowski; Bartosz Zawadzki; Zuzanna Walczak; Katarzyna Naja; Tomasz Adam Szczepanowski; Krzysztof Bednarski; Jakub Zwardoń; Natalia Kornacka; Anna Świerczek; Miłosz Rewekant

doi:10.31435/ijitss.2(50).2026.6115

Authors

Aleksander Gajkowski Samodzielny Publiczny Zespół Zakładów Opieki Zdrowotnej w Wyszkowie, Wyszków, Poland https://orcid.org/0000-0001-9130-5931
Bartosz Zawadzki Independent Public Health Care Institution of the Ministry of the Interior and Administration, Krakow, Lesser Poland, Poland https://orcid.org/0009-0004-9328-175X
Zuzanna Walczak 5th Military Clinical Hospital with Polyclinic SPZOZ, Kraków, Małopolska, Poland https://orcid.org/0009-0008-8417-5372
Katarzyna Naja National Medical Institute of the Ministry of the Interior and Administration, Warsaw, Poland https://orcid.org/0009-0008-6513-6984
Tomasz Adam Szczepanowski Samodzielny Publiczny Centralny Szpital Kliniczny, Warsaw, Mazovia, Poland https://orcid.org/0009-0006-2584-5554
Krzysztof Bednarski Beskid Oncology Center Municipal Hospital of John Paul II, Bielsko-Biała, Poland https://orcid.org/0009-0000-9801-2832
Jakub Zwardoń Dr Anna Gostynska Wolski Hospital, Marcina Kasprzaka 17, 01-211 Warsaw, Poland https://orcid.org/0009-0005-3944-2943
Natalia Kornacka Beskid Oncology Center Municipal Hospital of John Paul II, Wyzwolenia 18, 43-300 Bielsko-Biała, Poland https://orcid.org/0009-0003-3657-2027
Anna Świerczek Beskid Oncology Center Municipal Hospital of John Paul II, Wyzwolenia 18, 43-300 Bielsko-Biała, Poland https://orcid.org/0009-0006-9612-237X
Miłosz Rewekant Beskid Oncology Center Municipal Hospital of John Paul II, Wyzwolenia 18, 43-300 Bielsko-Biała, Poland https://orcid.org/0009-0004-3944-9363

DOI:

https://doi.org/10.31435/ijitss.2(50).2026.6115

Keywords:

Biomarkers, Enteric Nervous System, Gastrointestinal Microbiome, Irritable Bowel Syndrome

Abstract

Introduction: Post-infectious irritable bowel syndrome (PI-IBS) develops in approximately 14.5% of individuals after acute gastroenteritis and persists long-term, with emerging evidence suggesting an autoimmune component linking infection to chronic gastrointestinal dysfunction. This review aims to synthesize current literature on the proposed pathogenesis of PI-IBS, focusing on molecular mechanisms, the development of small intestinal bacterial overgrowth (SIBO), and resulting diagnostic and therapeutic implications.

Materials and methods: A narrative review of PubMed literature was performed, focusing on autoantibody-mediated disruption of gut motility, candidate diagnostic biomarkers, and emerging therapeutic approaches. Studies were selected based on relevance and methodological quality, without formal inclusion or exclusion criteria.

Results: Infection by cytolethal distending toxin (CDT)-producing bacteria triggers anti-CdtB antibody production, which through molecular mimicry may cross-react with human vinculin in the interstitial cells of Cajal, causing enteric neuropathy and impaired migrating motor complex function. The resulting dysmotility may facilitate SIBO development. Combined anti-CdtB and anti-vinculin serum biomarkers can offer post-test probability exceeding 98% for diarrhea-predominant IBS. Antibody-depleting therapies, such as plasmapheresis and intravenous immunoglobulin, may reduce autoantibody burden and correlate with symptomatic improvement.

Conclusions: PI-IBS may represent an immune-mediated consequence of acute bacterial gastroenteritis, in which CdtB-induced autoimmunity drives dysmotility and microbial dysbiosis. This mechanistic framework offers potential biomarkers and therapeutic targets. Further prospective studies are needed to validate these findings.

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