Gastroenterology

Gastroenterology

Volume 137, Issue 2, August 2009, Pages 495-501
Gastroenterology

Clinical—Alimentary Tract
Increased Short- and Long-Term Risk of Inflammatory Bowel Disease After Salmonella or Campylobacter Gastroenteritis

https://doi.org/10.1053/j.gastro.2009.04.001Get rights and content

Background & Aims

Various commensal enteric and potentially pathogenic bacteria may be involved in the pathogenesis of inflammatory bowel diseases (IBD). We compared the risk of IBD between a cohort of patients with documented Salmonella or Campylobacter gastroenteritis and an age- and gender-matched control group from the same population in Denmark.

Methods

We identified 13,324 patients with Salmonella/Campylobacter gastroenteritis from laboratory registries in North Jutland and Aarhus counties, Denmark, from 1991 through 2003, and 26,648 unexposed controls from the same counties. Of these, 176 exposed patients with IBD before the infection, their 352 unexposed controls, and 80 unexposed individuals with IBD before the Salmonella/Campylobacter infection were excluded. The final study cohort of 13,148 exposed and 26,216 unexposed individuals were followed for up to 15 years (mean, 7.5 years).

Results

A first-time diagnosis of IBD was reported in 107 exposed (1.2%) and 73 unexposed individuals (0.5%). By age, gender, and comorbidity adjusted Cox proportional hazards regression analysis, the hazard ratio (95% confidence interval) for IBD was 2.9 (2.2–3.9) for the whole period and 1.9 (1.4–2.6) if the first year after the Salmonella/Campylobacter infection was excluded. The increased risk in exposed subjects was observed throughout the 15-year observation period. The increased risk was similar for Salmonella (n = 6463) and Campylobacter (n = 6685) and for a first-time diagnosis of Crohn's disease (n = 47) and ulcerative colitis (n = 133).

Conclusions

In our population-based cohort study with complete follow-up, an increased risk of IBD was demonstrated in individuals notified in laboratory registries with an episode of Salmonella/Campylobacter gastroenteritis.

Section snippets

Setting

All Danish residents have a unique 10-digit personal identification number (the civil personal registry [CPR] number, which incorporates age and gender) used for all health contacts, which thus permits linkage between health administrative registries.21 The Danish health care system is tax financed and free of charge for all residents. Initial medical contact is with the general practitioner, who may refer the patient to a hospital in the patient's county of residence.

Study Cohort

Initially, we used a study

Baseline Characteristics

The initial cohort had 13,324 Salmonella/Campylobacter gastroenteritis exposed and 26,648 unexposed individuals.22 Of these, 176 exposed individuals (175 with IBD before the Salmonella/Campylobacter date and 1 with UC and CD diagnosed on the same date), their 352 unexposed matched individuals, and 80 unexposed individuals with IBD before the Salmonella/Campylobacter date were excluded, leaving 13,148 exposed and 26,216 unexposed individuals in the final study cohort (Table 1). The exclusions

Discussion

We found an increased risk of IBD in Salmonella or Campylobacter gastroenteritis patients as compared with an age- and gender-matched background population. This increased risk was highest during the first year but remained high up to 15 years after the Salmonella/Campylobacter gastroenteritis. The risk was higher in hospitalized than in nonhospitalized patients, whereas there were minor differences related to UC vs CD, Salmonella vs Campylobacter, age groups, and gender.

Furthermore, we used

References (36)

  • N. Barnich et al.

    Role of bacteria in the etiopathogenesis of inflammatory bowel disease

    World J Gastroenterol

    (2007)
  • P.D. Scanlan et al.

    Culture-independent analyses of temporal variation of the dominant fecal microbiota and targeted bacterial subgroups in Crohn's disease

    J Clin Microbiol

    (2006)
  • N. Barnich et al.

    Adherent-invasive Escherichia coli and Crohn's disease

    Curr Opin Gastroenterol

    (2007)
  • A. Stallmach et al.

    Role of infections in the manifestation or reactivation of inflammatory bowel diseases

    Inflamm Bowel Dis

    (2002)
  • M. Mylonaki et al.

    Enteric infection in relapse of inflammatory bowel disease: importance of microbiological examination of stool

    Eur J Gastroenterol Hepatol

    (2004)
  • F. Kallinowski et al.

    Prevalence of enteropathogenic bacteria in surgically treated chronic inflammatory bowel disease

    Hepatogastroenterology

    (1998)
  • G. Schumacher et al.

    A prospective study of first attacks of inflammatory bowel disease and non-relapsing colitisMicrobiologic findings

    Scand J Gastroenterol

    (1993)
  • P. Weber et al.

    Microbic superinfection in relapse of inflammatory bowel disease

    J Clin Gastroenterol

    (1992)

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    Conflicts of interest The authors disclose no conflicts.

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