title: Infectious Gastroenteritis as a Risk Factor for Tropical Sprue and Malabsorption: A Case-Control Study.
abstract: BACKGROUND
  Previous studies have linked an increase in functional and pathological gastrointestinal (GI) disorders following antecedent infectious gastroenteritis (IGE), yet studies of other chronic GI disorders such as tropical sprue (TS) and intestinal malabsorption (IM) are lacking. This study was performed to evaluate the association between documented IGE and the risk of TS and IM using a matched case-control study.
  
  
  METHODS
  The odds of IGE (exposure) among subjects with TS and IM were compared to the odds of exposure in matched controls. Data were obtained from the Defense Medical Surveillance System. Incidence was estimated based on the number of active duty military personnel, and conditional logistic regression models were used to evaluate the relationship between IGE and TS/IM while adjusting for potential confounders.
  
  
  RESULTS
  The overall incidence of TS and IM was 0.24 and 1.98 per 100,000 person-years, respectively. After adjusting for important covariates, prior IGE was associated with an increase in the odds of TS (odds ratio (OR) 36.64) and IM (OR 3.93) (p < 0.001). Other covariates demonstrating an increased risk were being of Caucasian race, having greater than high school education, and service in military branches other than the Army.
  
  
  CONCLUSIONS
  Overall, this study demonstrates the first significant estimates that a case of antecedent IGE is associated with an increased risk of TS and IM in an active duty military population. Ultimately, acquisition of TS or IM has the potential to decrease operational efficiency, which may have a significant impact on deployed military missions.
authors.affiliation: Department of Epidemiology and Biostatistics, George Washington University, Washington, DC, 20037, USA.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: McCarroll
authors.affiliation: Enteric Disease Department, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD, 20910, USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Riddle
authors.affiliation: Enteric Disease Department, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD, 20910, USA.
authors.forename: Ramiro L
authors.initials: RL
authors.lastname: Gutierrez
authors.affiliation: Enteric Disease Department, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD, 20910, USA. chad.k.porter2.civ@mail.mil.
authors.forename: Chad K
authors.initials: CK
authors.lastname: Porter
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D004403:Dysentery / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008286:Malabsorption Syndromes / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008887:Military Medicine; D008889:Military Personnel; D015999:Multivariate Analysis; D016017:Odds Ratio; D012307:Risk Factors; D013182:Sprue, Tropical / Q000175:diagnosis / Q000453:epidemiology*; D013997:Time Factors; D014481:United States; D055815:Young Adult
keywords: Infectious gastroenteritis; Intestinal malabsorption; Military; Tropical sprue