title: Salmonella gastroenteritis during childhood is a risk factor for irritable bowel syndrome in adulthood.
abstract: OBJECTIVE
  Acute infectious gastroenteritis increases the risk for irritable bowel syndrome (IBS) and functional dyspepsia (FD). Children are particularly vulnerable to gastroenteritis because of the immaturity of their intestinal barrier, enteric nervous system, and immune response to pathogens. We investigated whether acute gastroenteritis in early life increases the risk of IBS and FD throughout adulthood.
  
  
  METHODS
  In 1994, we identified and monitored a single culture-proven foodborne Salmonella enteritidis outbreak that involved 1811 patients (mostly pediatric) in Bologna, Italy. Clinical data were collected and a prospective, controlled, cohort study was designed. Long-term effects were assessed by mailing a questionnaire to 757 subjects 16 years after the outbreak (when all of the children were adults). We randomly selected a cohort of 250 adults exposed to Salmonella as children, all 127 individuals exposed as adults, and a cohort of nonexposed participants matched for number, age, sex, and area of residence (controls).
  
  
  RESULTS
  Among 198 exposed participants, 64 reported FD (32.3%), compared with 51 of 188 controls (27.1%; P = .268). Among 204 exposed participants, 75 reported having IBS (36.8%) compared with 44 of 189 controls (23.3%; P = .004). The odds ratio for IBS among people exposed to the Salmonella was 1.92 (95% confidence interval: 1.23-2.98). The prevalence of IBS was higher in individuals exposed Salmonella as children than in controls (35.3% vs 20.5%; P = .008), but not in individuals exposed as adults, compared with controls. After multivariate logistic regression, post-infectious IBS was independently associated with anxiety and FD.
  
  
  CONCLUSIONS
  Based on data collected from a single culture-proven foodborne Salmonella enteritidis outbreak in 1994, Salmonella-induced gastroenteritis during childhood (but not adulthood) is a risk factor for IBS.
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Cremon
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Stanghellini
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Pallotti
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Fogacci
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Italy.
authors.forename: Lara
authors.initials: L
authors.lastname: Bellacosa
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Italy.
authors.forename: Antonio M
authors.initials: AM
authors.lastname: Morselli-Labate
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Italy.
authors.forename: Alexandro
authors.initials: A
authors.lastname: Paccapelo
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Nardo
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Italy.
authors.forename: Rosanna F
authors.initials: RF
authors.lastname: Cogliandro
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: De Giorgio
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Corinaldesi
authors.affiliation: Department of Medical and Surgical Sciences, University of Bologna, Italy. Electronic address: giovanni.barbara@unibo.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Barbara
mesh_terms: D000328:Adult; D000367:Age Factors; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005759:Gastroenteritis / Q000150:complications* / Q000382:microbiology*; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000453:epidemiology*; D007558:Italy; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D012480:Salmonella Infections / Q000150:complications*; D012477:Salmonella enteritidis; D011795:Surveys and Questionnaires
keywords: Bacteria; Epidemiology; Food Poisoning; Outcome