title: Pathogen-specific risk of chronic gastrointestinal disorders following bacterial causes of foodborne illness.
abstract: BACKGROUND
  The US CDC estimates over 2 million foodborne illnesses are annually caused by 4 major enteropathogens: non-typhoid Salmonella spp., Campylobacter spp., Shigella spp. and Yersinia enterocoltica. While data suggest a number of costly and morbid chronic sequelae associated with these infections, pathogen-specific risk estimates are lacking. We utilized a US Department of Defense medical encounter database to evaluate the risk of several gastrointestinal disorders following select foodborne infections.
  
  
  METHODS
  We identified subjects with acute gastroenteritis between 1998 to 2009 attributed to Salmonella (nontyphoidal) spp., Shigella spp., Campylobacter spp. or Yersinia enterocolitica and matched each with up to 4 unexposed subjects. Medical history was analyzed for the duration of military service time (or a minimum of 1 year) to assess for incident chronic gastrointestinal disorders. Relative risks were calculated using modified Poisson regression while controlling for the effect of covariates.
  
  
  RESULTS
  A total of 1,753 pathogen-specific gastroenteritis cases (Campylobacter: 738, Salmonella: 624, Shigella: 376, Yersinia: 17) were identified and followed for a median of 3.8 years. The incidence (per 100,000 person-years) of PI sequelae among exposed was as follows: irritable bowel syndrome (IBS), 3.0; dyspepsia, 1.8; constipation, 3.9; gastroesophageal reflux disease (GERD), 9.7. In multivariate analyses, we found pathogen-specific increased risk of IBS, dyspepsia, constipation and GERD.
  
  
  CONCLUSIONS
  These data confirm previous studies demonstrating risk of chronic gastrointestinal sequelae following bacterial enteric infections and highlight additional preventable burden of disease which may inform better food security policies and practices, and prompt further research into pathogenic mechanisms.
authors.affiliation: Enteric Diseases Department, Naval Medical Research Center, Silver Spring, MD, USA. chad.porter@med.navy.mil
authors.forename: Chad K
authors.initials: CK
authors.lastname: Porter
authors.forename: Daniel
authors.initials: D
authors.lastname: Choi
authors.forename: Brooks
authors.initials: B
authors.lastname: Cash
authors.forename: Mark
authors.initials: M
authors.lastname: Pimentel
authors.forename: Joseph
authors.initials: J
authors.lastname: Murray
authors.forename: Larissa
authors.initials: L
authors.lastname: May
authors.forename: Mark S
authors.initials: MS
authors.lastname: Riddle
mesh_terms: D000328:Adult; D002167:Campylobacter / Q000302:isolation & purification*; D002169:Campylobacter Infections / Q000150:complications; D002908:Chronic Disease; D003248:Constipation / Q000453:epidemiology / Q000382:microbiology; D004405:Dysentery, Bacillary / Q000150:complications; D005260:Female; D005517:Foodborne Diseases / Q000150:complications* / Q000382:microbiology*; D005764:Gastroesophageal Reflux / Q000453:epidemiology / Q000382:microbiology; D005767:Gastrointestinal Diseases / Q000453:epidemiology* / Q000382:microbiology*; D006801:Humans; D015994:Incidence; D043183:Irritable Bowel Syndrome / Q000453:epidemiology / Q000382:microbiology; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012475:Salmonella / Q000302:isolation & purification*; D012480:Salmonella Infections / Q000150:complications; D012760:Shigella / Q000302:isolation & purification*; D015007:Yersinia / Q000302:isolation & purification*; D015009:Yersinia Infections / Q000150:complications