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Gut Pathog. 2017 Dec 14;9:75. doi: 10.1186/s13099-017-0224-7. eCollection 2017.

Exposure to environmental microbiota explains persistent abdominal pain and irritable bowel syndrome after a major flood.

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School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan Malaysia.
Department of Public Health, Xi'an Jiaotong-Liverpool University, Suzhou, China.
De La Salle Health Sciences Institute, Dasmarinas, Cavite Philippines.
School of Medical and Health Sciences, Edith Cowan University, Perth, Australia.
School of Industrial Technology, Universiti Sains Malaysia, Gelugor, Penang Malaysia.
Next Generation Science Institute, Morinaga Milk Industry Co., Ltd., Tokyo, Japan.
Contributed equally



After an environmental disaster, the affected community is at increased risk for persistent abdominal pain but mechanisms are unclear. Therefore, our study aimed to determine association between abdominal pain and poor water, sanitation and hygiene (WaSH) practices, and if small intestinal bacterial overgrowth (SIBO) and/or gut dysbiosis explain IBS, impaired quality of life (QOL), anxiety and/or depression after a major flood.


New onset abdominal pain, IBS based on the Rome III criteria, WaSH practices, QOL, anxiety and/or depression, SIBO (hydrogen breath testing) and stools for metagenomic sequencing were assessed in flood victims. Of 211 participants, 37.9% (n = 80) had abdominal pain and 17% (n = 36) with IBS subtyped diarrhea and/or mixed type (n = 27 or 12.8%) being the most common. Poor WaSH practices and impaired quality of life during flood were significantly associated with IBS. Using linear discriminant analysis effect size method, gut dysbiosis was observed in those with anxiety (Bacteroidetes and Proteobacteria, effect size 4.8), abdominal pain (Fusobacteria, Staphylococcus, Megamonas and Plesiomonas, effect size 4.0) and IBS (Plesiomonas and Trabulsiella, effect size 3.0).


Disturbed gut microbiota because of environmentally-derived organisms may explain persistent abdominal pain and IBS after a major environmental disaster in the presence of poor WaSH practices.


Abdominal pain; Dysbiosis; Flood; Malaysia; Sanitation and hygiene practices; Small intestinal bacterial overgrowth; Water

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