View source for Post-infectious lactose intolerance and irritable bowel syndrome

== Background ==
* Definition is IBS meeting Rome criteria that immediately follows a gastrointestinal illness characterized by at least two of fever, vomiting, diarrhea, or positive stool culture

== Clinical Presentation ==
* Diarrheal illness followed by persistent diarrhea despite appropriate treatment
* Can occur following [[dysentery]] or ''[[C. difficile]]'' infection

== Management ==
* '''Week one: lactose-free diet'''
** Avoid all lactose-containing foods, including milk and milk products like cheese, cream, yoghurt, and ice creams
** If symptoms significantly improve, continue the lactose-free diet
** If symptoms do not significantly improve, proceed to week two
* '''Week two: high-fibre diet'''
** Start metamucil (psyllium fibre) 1-2 '''tablespoons''' in a glass of juice or water daily, followed by another glass of juice or water
*** May cause bloating and gas (which improve), or rare allergy
*** Use sugar-free metamucil
** Start PEG 3350 1-2 tablespoons once daily (can be mixed with metamucil)
*** May cause bloating and gas
** Consider avoiding alcohol, caffeine, spicy food, stress, and gas-producing foods (broccoli, cabbage, Brussels sprouts, beans, etc.) which can trigger or worsen irritable bowel syndrome

== Prognosis ==
* Lasts a median of 2 years

== Further Reading ==
* Postinfectious irritable bowel syndrome. ''Gastroenterology''. 2009;136(6):1979-88. doi: [https://doi.org/10.1053/j.gastro.2009.02.074 10.1053/j.gastro.2009.02.074].

[[Category:Gastrointestinal infections]]