Extract

The persistence of gastrointestinal symptoms after travel is a perplexing issue. Once thought to be mainly due to parasites that could not be found, in recent years it has been postulated that travellers who have a bout of gastroenteritis while travelling are at risk of developing post-travel irritable bowel symptoms that can persist for months or years. A recent review found there was a 4-fold increase in the risk of developing irritable bowel symptoms in the 12 months after a single bout of gastroenteritis; more significantly, the risk of persistent symptoms after a protozoal infection was 42%.1 For the patient with persistent abdominal symptoms (PAS) after travel, the problem has been to determine whether an active infection is still present, what diagnostic tests are necessary before it can be said that no pathogen is present, and what is the role of empiric treatment for protozoal infections in the absence of a positive finding. Although experts have long advocated the use of empiric treatment for protozoa at some point in the post-travel evaluation, studies assessing the outcome of these recommendations have been rare.2,3

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