OBJECTIVE:Data suggest that subjects with irritable bowel syndrome are more likely to report a recent course of antibiotics. This study tests the hypothesis that a course of antibiotics is a risk factor for an increase in the number of functional bowel complaints over a 4-month period in a general population sample.METHODS:We initiated a prospective case-control study in three general practices in South London. Consecutive patients aged 16–49 attending their general practitioner with non-GI complaints and given a prescription for antibiotics were invited to participate. Comparison subjects who had not had antibiotics for 1 yr were identified from the practice records by age group, gender, and previous general practitioner visits. Fifty-eight antibiotic and 65 control patients agreed to participate. Questionnaires covering demographic, GI, and psychological data were sent at recruitment and at 4 months. Seventy-four percent of subjects completed the study. The number of symptoms at follow-up compared to that at recruitment.RESULTS:Twenty of 42 antibiotic subjects (48%) versus 11/49 control subjects (22%) demonstrated one or more additional functional bowel symptoms at 4 months (unadjusted odds ratio = 3.14 [1.27–7.75]) (χ2= 6.4, p = 0.01). Ten of 42 antibiotic subjects (24%) versus 3/49 control subjects (6%) demonstrated two or more additional functional bowel symptoms at 4 months (unadjusted odds ratio = 4.79 [1.22–18.80]) (χ2= 5.8, p = 0.02).CONCLUSIONS:Functional bowel symptoms come and go, but subjects who are given a course of antibiotics are more than three times as likely to report more bowel symptoms 4 months later than controls.

(1999). Anorectal Sensation and Continence. Scandinavian Journal of Gastroenterology: Vol. 34, No. 2, pp. 113-116.

Irritable bowel syndrome (IBS) has confounded clinicians for over a century. “Mucous colitis” was first described by Osler in 1892. He wrote of a disorder characterised by the passage of tubular casts of the colon, consisting of mucus (mucorrhoea), cell debris, and “intestinal sand”. Osler stated that the colonic epithelium was normal and that many of the patients were hysterical, hypochondriac, or depressed, and suffered from colicky abdominal pains. This condition was also recognised by Hurst, but the disease they described seemed to have disappeared from both clinical practice and medical texts by the late 1920s. The term “mucous colitis” persisted with a new definition, such that by 1928 it described only colonic spasm. The term “irritable colon” first appeared in published research in 1929 when Jordan and Kiefer used it to describe a colonic musculoneural disturbance present in 30% of gastroenterology outpatients. Irrritable colon described abdominal pain and disordered defaecation; it thus had a meaning similar to its present one.