1270. Pscyhological Stress (PS) as a Risk Factor for the Development of Travelers’ Diarrhea (TD) and Post-Travel Persistent Abdominal Symptoms (PAS) Including Irritable Bowel Syndrome (IBS)
Session: Poster Abstract Session: Travel/Tropical Medicine and Parasitology
Saturday, October 22, 2011
Room: Poster Hall B1
Background:  Travelers to foreign countries experience PS. PS can lead to decreased secretory IgA levels. Stress-related psychiatric disorders, anxiety and depression, are related to IBS.  

Objective: To examine the relationship between travelers’ stress and development of acute TD and post-travel PAS including IBS.

Methods: 231 travelers to Guadalajara, Mexico were followed prospectively during the 2004 summer for TD and at 6 months post-travel for postinfectious-IBS (PI-IBS) or functional abdominal disorder (FAD) by Rome II criteria.  Subjects with PI-IBS or FAD were considered to have PAS. TD was defined as >3 unformed stools within a 24-hr period with >1 enteric infection symptom. TD stools were assayed for enterotoxigenic (ETEC) and enteroaggregative (EAEC) E. coli, and other traditional enteropathogens. Subjects completed the Perceived Stress Scale (PSS) in <3 days of arrival and departure from Mexico. The Brief Symptom Inventory (BSI) was completed in <3 days of arrival and then weekly in Mexico. 

Results: (Insert Table)

Baseline stress scores were similar between TD subjects and healthy travelers, between PI-IBS and non- PI-IBS travelers, and between PAS and non-PAS travelers. Baseline stress and preceding weekly stress scores were not associated with TD. Higher PSS stress scores at departure were associated with PI-IBS and PAS development.

Conclusion:

Stress was not associated with TD or FAD susceptibility. Higher stress levels experienced by travelers to Mexico may be an important determinant for PI-IBS and PAS development following TD. Our findings support the importance of psychological stress and enteric infection in the pathogenesis of PI-IBS.

Study Participants

Arrival PSS Score (mean+SD)

(n=231)

P value

Departure PSS score (mean + SD)

(n=220)

P value

Weekly BSI score (mean + SD)

(n=180)

P value

 

TD

27.7 + 3.7

0.41

23.7 + 4.1

0.49

47.9 + 8.7

0.59

non-TD

27.3 + 3.7

 

23.3 + 4.3

 

47.4 +  9.1

 

ETEC TD

27.1 +  2.9

0.62

23.5 + 3.1

0.65

49.0 +  7.7

0.21

non-ETEC TD

27.4 +  3.8

 

23.2 +  4.2

 

47.3 + 9.0

 

EAEC TD

27.3 + 3.5

0.77

23.3 +  4.0

0.94

49.3 + 8.6

0.26

non-EAEC TD

27.4 + 3.7

 

23.2 + 4.1

 

47.3 +  8.9

 

PI-IBS

27.9 +  3.6

0.39

25.0 + 3.6

0.01

-

-

non-PI-IBS

27.2 + 3.6

 

23.0 +  4.3

 

-

 

FAD

28.6 + 4.6

0.13

25.2 + 5.3

0.22

-

-

non-FAD

27.2 + 3.5

 

23.3 + 4.1

 

-

 

PAS

28.1 + 3.9

0.08

25.1 + 4.1

0.003

-

-

non-PAS

27.0 + 3.4

 

22.7 + 4.2

 

-

 


Subject Category: T. Travel/tropical medicine and parasitology

Hoonmo Koo, MD, Baylor College of Medicine, University of Texas-Houston School of Public Health, Houston, TX, Pablo Okhuysen, MD, The University of Texas-Houston Medical School, Houston, TX, Zhi-Dong Jiang, MD, PhD, The University of Texas Houston School of Public Health, Houston, Texas, TX, Parvathy Nair, MD, University of Texas Medical School, Houston, TX, Gailen Marshall, MD, University of Mississippi Medical Center, Jackson, MS, Herbert DuPont, MD, St. Luke's Episcopal Hospital and Kelsey Research Foundation and Kelsey-Seybold Clinic, Houston, TX and Charles Ericsson, MD, University of Texas Houston-Medical School, Houston, TX

Disclosures:

H. Koo, None

P. Okhuysen, None

Z. D. Jiang, None

P. Nair, None

G. Marshall, None

H. DuPont, None

C. Ericsson, None

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