Acute Gastroenteritis Is Followed by an Increased Risk of Inflammatory Bowel Disease

doi:10.1053/j.gastro.2006.02.004

Gastroenterology

Volume 130, Issue 6, May 2006, Pages 1588-1594

https://doi.org/10.1053/j.gastro.2006.02.004 Get rights and content

Background & Aims: Bacterial intestinal infections have been implicated as a possible cause of exacerbation of inflammatory bowel disease (IBD). We explored the relationship between infectious gastroenteritis and the occurrence of IBD using data from the General Practice Research Database. Methods: A cohort of patients aged 20–74 years with an episode of acute infectious gastroenteritis (n = 43,013) was identified. From the same source population, an age-, sex-, and calendar time-matched control group free of gastroenteritis was sampled (n = 50,000). Both cohorts were followed up for a mean duration of 3.5 years. Results: The estimated incidence rate of IBD was 68.4 per 100,000 person-years after an episode of gastroenteritis and 29.7 per 100,000 person-years in the control cohort. The hazard ratio of IBD was 2.4 (95% confidence interval [CI], 1.7–3.3) in the gastroenteritis cohort compared with the control cohort, and the excess risk was greater during the first year after the infective episode (hazard ratio, 4.1; 95% CI, 2.2–7.4). The relative risk of developing Crohn’s disease in the gastroenteritis cohort was greater than that of ulcerative colitis, especially during the first year after the infective episode (hazard ratio, 6.6; 95% CI, 1.9–22.4). Conclusions: Our results are compatible with the hypothesis that infectious agents causing an episode of infectious gastroenteritis could play a role in the initiation and/or exacerbation of IBD.

Section snippets

Study Population

We explored the relationship between infectious GE and the occurrence of IBD, including Crohn’s disease (CD), ulcerative colitis (UC), and indeterminate colitis, using data from the General Practice Research Database. The database is composed of computerized medical records of approximately 2000 general practitioners from the United Kingdom and is managed by the United Kingdom’s Medicines and Healthcare Products Regulatory Agency.⁸ The age and sex distribution of the population served by

Results

During a mean follow-up period of 3.5 years (range, 0–10 years; SD, 2.3 years), we ascertained 108 patients with a first-ever diagnosis of IBD in the GE cohort and 50 in the comparison cohort. Table 1 presents a summary description of IBD cases occurring in the GE cohort and comparison cohort. Forty were diagnosed with CD, 64 with UC, and 4 as IBD type unclassified in the GE cohort. The distribution by type of IBD occurring in the comparison cohort free of GE was similar to that in the GE

Discussion

The incidence rate of IBD in our cohort of 43,013 patients with an episode of GE was 68 per 100,000 person-years, a doubling of the risk observed in the control cohort of individuals free of GE. To our knowledge, this is the first large epidemiologic study providing evidence on the association between an episode of GE and the occurrence of IBD. The nested case-control analysis gave results similar to the cohort analysis, with the sole difference of slightly smaller estimates of risk after

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: Supported in part by a research grant from AstraZeneca R&D, Sweden, and grant C03/02 from Instituto de Salud Carlos III (to J.P.).

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Clinical–alimentary tractAcute Gastroenteritis Is Followed by an Increased Risk of Inflammatory Bowel Disease

Section snippets

Study Population

Results

Discussion

Gastroenterology

J Clin Epidemiol

Gastroenterology

Gastroenterology

Gastroenterology

Immunity

Yersinia colitis associated with Crohn’s disease

Postgrad Med J

Ulcerative post-dysenteric colitis

Gut

A prospective study of first attacks of inflammatory bowel disease and non-relapsing colitis. Microbiologic findings

Scand J Gastroenterol

Prevalence of enteropathogenic bacteria in surgically treated chronic inflammatory bowel disease

Hepatogastroenterology

Microbic superinfection in relapse of inflammatory bowel disease

J Clin Gastroenterol

Clinical–alimentary tract
Acute Gastroenteritis Is Followed by an Increased Risk of Inflammatory Bowel Disease