Risk of irritable bowel syndrome after an episode of bacterial gastroenteritis in general practice: influence of comorbidities.
OBJECTIVE
Given the discrepant estimates of incidence rates of irritable bowel syndrome (IBS) after gastroenteritis (GE), we performed a cohort study to quantify this risk in community subjects and to identify factors acting as modifiers of this effect.


METHODS
In a previous study, we identified patients aged 20-74 years with a first ever episode of bacterial GE during 1992-2001. We excluded patients with a history of bowel disease and cancer, resulting in a cohort of 5894 individuals with GE. From the same source population, a control group free of GE was sampled. We followed up the 2 cohorts to identify incident cases of IBS. A nested case-control analysis was performed to quantify the role of potential risk factors.


RESULTS
During a mean follow-up period of 4.1 years, 1105 patients developed IBS. The incidence rate of IBS after an episode of bacterial GE was 98.2 per 10,000 person-years, and 45.3 per 10,000 person-years in the comparison cohort. The adjusted relative risk of IBS associated with bacterial GE was 2.2 (1.5-2.9) compared with the control cohort. The nested case-control analysis adjusting for additional risk factors produced similar results (odds ratio, 1.8; 95% confidence interval, 1.5-2.1). The risk of IBS after GE was increased significantly in patients with depression, anxiety, stress or sleep disorders, prior gastrointestinal morbidity, or prolonged use of antibiotics.


CONCLUSIONS
The risk of IBS in community individuals after having bacterial GE was two fold greater in the general population. Pre-existing psychologic and gastrointestinal comorbidities independently increase this risk of developing IBS.
Ruigómez
Ana
A
Centro Español de Investigación Farmacoepidemiológica, Madrid, Spain.
García Rodríguez
Luis Alberto
LA
Panés
Julián
J
D000328:Adult; D017677:Age Distribution; D000368:Aged; D001424:Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology; D016022:Case-Control Studies; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D005759:Gastroenteritis / Q000453:epidemiology* / Q000382:microbiology*; D006801:Humans; D015994:Incidence; D043183:Irritable Bowel Syndrome / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011336:Probability; D012016:Reference Values; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D013030:Spain / Q000453:epidemiology