الفهرس 
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Abstract
Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder in which abdominal pain is associated with a defect or a change in bowel habits. Gut inflammation is one of the proposed mechanisms of pathogenesis. The pathophysiology of IBS remains incompletely understood. Recent studies have described a possible role for protozoan parasites, such as Blastocystis hominis and Dientamoeba fragilis, in the etiology of IBS.
The present work aimed to identify intestinal protozoa in confirmed IBS cases compared to patients with gastrointestinal symptoms not fulfilling IBS criteria and healthy controls.
The present study was carried out on 120 subjects including 40 IBS patients, 40 patients with gastrointestinal symptoms not fulfilling IBS criteria and 40 healthy controls. Demographic and medical data were recorded and stool samples were collected for parasitological examination.
Our results summarized that:
- There was no statistically significant difference between the three groups regarding age and sex. All participants were residing in urban areas of Alexandria.
- According to Rome III subtyping of IBS, 11 patients (27.5%) were classified as IBS-D, 12 patients (30%) as IBS-C and another 12 patients (30%) as IBS-M 5 Un-subtyped.
- Abdominal pain was recorded in all patients of both groups. A significantly greater percentage of IBS patients had pain relief by defecation compared to non-IBS patients (55% versus 20%). Also, diarrhea, constipation and alternating diarrhea and constipation were recorded in greater percentages of IBS (27.5%, 30% and 30% respectively) compared to the non-IBS group (22.5, 22.5%, 15% respectively) but this did not reach level of significance.
- Positive history of recent acute gastroenteritis was recorded in 50% of IBS cases and 30% of non-IBS patients.
- H. pylori infection was recorded in 25% of IBS patients and 30% of non-IBS cases with non-statistically significant difference.
- The overall percentage of parasitic infections was significantly higher in IBS (50%) and non-IBS patients (35%) compared to the healthy controls (12.5%). Mixed protozoal infection was observed only in patients with GIT disorders, whether IBS or non-IBS.
- B. hominis was the most commonly diagnosed organism in all groups. It was found in a significantly higher percentage of IBS patients (45%) compared to the non-IBS group (20%) and the healthy control group (10%).
- There was no significant difference between the studied groups regarding the percentage of E.histolytica /E.dispar and the non- pathogenic protozoan E. coli.
Summary
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D. fragilis was identified in only two IBS patients (5%) while G.lamblia and C. cayetanensis were found in non-IBS patients (5% and 2.5% respectively).
- Trichrome staining was the most sensitive technique as it detected all positive cases.
- Univariate analysis revealed that protozoal infection was significantly associated with the presence of GIT disorders (IBS or non-IBS), having abdominal pain or abnormal bowel habits and history of acute gastroenteritis, or intake of PPIs.
- Multivariate analysis revealed that recent history of acute gastroenteritis was the only factor that was independently associated with intestinal protozoan infection among the study subjects
- Among IBS patients, no relation could be observed between infection with Blastocystis spp. and demographic factors (age and gender), IBS subtype, history of acute gastroenteritis, intake of drugs (antibiotics, anti-parasitic, or PPIs or infection with H.pylori.