title: Perceived food intolerance and irritable bowel syndrome in a population 3 years after a giardiasis-outbreak: a historical cohort study.
abstract: BACKGROUND
  Studies have shown an increased prevalence of irritable bowel syndrome (IBS) after acute gastroenteritis. Food as a precipitating and perpetuating factor in IBS has gained recent interest, but food intolerance following gastroenteritis is less investigated. The aims of this study were firstly, to compare perceived food intolerance in a group previously exposed to Giardia lamblia with a control group; secondly, to explore the relation with IBS status; and thirdly, to investigate associations with content of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) in foods reported.
  
  
  METHODS
  This is a historical cohort study with mailed questionnaire to 1252 Giardia exposed and a control cohort matched by gender and age. Differences between groups were investigated using bivariate and multivariate analyses.
  
  
  RESULTS
  The questionnaire response rate in the exposed group was 65.3 % (817/1252) and in the control group 31.4 % (1128/3598). The adjusted odds ratio (OR) for perceived food intolerance for the exposed group was 2.00 with 95 % confidence interval (CI): 1.65 to 2.42, as compared with the control group. Perceived intolerance for dairy products was the most frequently reported intolerance, with an adjusted OR for the exposed of 1.95 (95 % CI: 1.51 to 2.51). Perceived intolerance for fatty foods, vegetables, fruit, cereals and alcohol was also significantly higher in the exposed group. The groups did not differ in perceived intolerance to spicy foods, coffee or soda. The association between exposure to Giardia infection and perceived food intolerance differed between the IBS group and the no-IBS group, but IBS was not a significant effect modifier for the association. Perceived intolerance for high FODMAP foods (adjusted OR 1.91) and low FODMAP foods (adjusted OR 1.55) was significantly associated with exposure status.
  
  
  CONCLUSIONS
  Exposure to Giardia infection was associated with perceived food intolerance 3 years after giardiasis. IBS status did not alter the association between exposure status and perceived food intolerance. Perceived intolerance to high FODMAP foods and low FODMAP foods were both statistically significantly associated with exposure to Giardia infection.
authors.affiliation: Research Unit for General Practice, Uni Research Health, Kalfarveien 31, N-5018, Bergen, Norway. sverre.litleskare@uni.no.
authors.forename: Sverre
authors.initials: S
authors.lastname: Litleskare
authors.affiliation: Research Unit for General Practice, Uni Research Health, Kalfarveien 31, N-5018, Bergen, Norway. knut-arne.wensaas@uni.no.
authors.forename: Knut-Arne
authors.initials: KA
authors.lastname: Wensaas
authors.affiliation: Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway. geir.egil.eide@helse-bergen.no.|Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. geir.egil.eide@helse-bergen.no.
authors.forename: Geir Egil
authors.initials: GE
authors.lastname: Eide
authors.affiliation: National Centre for Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway. kurt.hanevik@uib.no.|Department of Clinical Science, University of Bergen, Bergen, Norway. kurt.hanevik@uib.no.
authors.forename: Kurt
authors.initials: K
authors.lastname: Hanevik
authors.affiliation: Department of Clinical Nutrition, Haukeland University Hospital, Bergen, Norway. gudrun.elise.kahrs@helse-bergen.no.
authors.forename: Gudrun Elise
authors.initials: GE
authors.lastname: Kahrs
authors.affiliation: Department of Clinical Science, University of Bergen, Bergen, Norway. nina.langeland@uib.no.
authors.forename: Nina
authors.initials: N
authors.lastname: Langeland
authors.affiliation: Research Unit for General Practice, Uni Research Health, Kalfarveien 31, N-5018, Bergen, Norway. guri.rortveit@uib.no.|Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. guri.rortveit@uib.no.
authors.forename: Guri
authors.initials: G
authors.lastname: Rortveit
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D005260:Female; D005285:Fermentation; D005502:Food; D005512:Food Hypersensitivity / Q000453:epidemiology* / Q000209:etiology; D005873:Giardiasis / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D043183:Irritable Bowel Syndrome / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D016017:Odds Ratio; D010465:Perception; D015995:Prevalence; D011795:Surveys and Questionnaires; D055815:Young Adult