Risk of IBD Increases After Salmonella Or Campylobacter Gastroenteritis

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IBD risk of IBD increases after Salmonella or Campylobacter gastroenteritis

he pathogenesis of iBD involves many genetic and environmental tfactors, including enteric bacteria that may trigger or exacerbate the disease. Few human studies of iBD have focused on pathogenic bacteria that cause gastroenteritis other than Mycobacterium paratuberculosis and adherent-invasive Escherichia coli, even though adhesion of bacteria and increased permeability of the intestinal mucosa in this illness is important in the pathogenesis of iBD. a population- based cohort long-term follow-up study now shows that gastroenteritis caused by infection with nontyphoid Salmonella or Wikipedia thermophilic Campylobacter increases a first-time diagnosis of iBD was nonhospitalized patients. the increased the risk of developing iBD. “the potential reported in 107 exposed (1.2%) and 73 risk was similar for a Salmonella or a consequences of foodborne bacterial unexposed individuals (0.5%); 14 of these Campylobacter infection, and for a first- infections may not be as trivial as many had both ulcerative colitis and Crohn’s time diagnosis of ulcerative colitis or people think”, comments corresponding disease. when adjusted for age, gender and Crohn’s disease. author, Henrik nielsen. comorbidities, the hazard ratio (Hr) for to check for possible surveillance a total of 13,324 Danish residents iBD was 2.9 (Ci 2.2–3.9). During the first bias, such as whether individuals with a with a first-time detection of Salmonella year after infection, the incidence of iBD Salmonella or Campylobacter infection or Campylobacter in stool specimens increased steeply in exposed individuals developed gastroenteritis because of the were included in the study cohort, but remained close to zero in unexposed presence of undiagnosed iBD, the authors and were matched with 26,648 unexposed individuals. Salmonella or Campylobacter evaluated the number of cultured stool individuals on the specimen receipt date, gastroenteritis was probably not the trigger specimens of 20.2% of the exposed and according to age, gender and county of iBD diagnosed within a few months of unexposed individuals in the study cohort. of residence. 176 exposed individuals infection, because patients usually report although patients with iBD had more and their 352 unexposed matched symptoms of ulcerative colitis and Crohn’s specimens cultured than patients without individuals were excluded because disease months or years before their first iBD, the bacteria were generally detected they had iBD before gastroenteritis, as admission to hospital. For that reason, the in the first specimen taken, thus making were 80 unexposed individuals who authors also calculated the Hr excluding surveillance bias unlikely. had iBD before the specimen receipt the first year after the specimen receipt “Focused studies involving new cases date. the study cohort was linked to date—this Hr was 1.9 (Ci 1.4–2.6). with mucosal biopsy samples, to assess the Danish national Patient registry to among all exposed patients, 28.3% immunological factors and inflammation, identify all diagnoses of ulcerative colitis were hospitalized for their gastroenteritis, and genetic marker assessment in cases and Crohn’s disease. “our study is very whereas 44.9% of the patients with iBD versus controls, would be useful,” concludes strong from an epidemiological point of were hospitalized for their iBD. at 15 nielsen. Clinicians should be aware of view, as we included all cases in a well- years 1.2% of exposed individuals and the higher risk of iBD in patients with defined population, thanks to complete 0.5% of unexposed individuals had been Salmonella or Campylobacter gastroenteritis. registration of all health contacts in diagnosed as having iBD. the distribution Ezzie Hutchinson Denmark, and we were able to follow of mild and moderate or severe cases of the patients for up to 15 years”, says iBD, as determined by proxy by the nielsen. “moreover, diagnosis of number of visits to hospital, did not Original article Gradel, K. O. et al. Increased short- iBD is centralized to departments differ between exposed or unexposed and long-term risk of inflammatory bowel disease of gastroenterology and all cases are individuals, but the risk of developing after Salmonella or Campylobacter gastroenteritis. Gastroenterology 137, 495–501 (2009). registered in a national database.” iBD was higher in hospitalized than in

nature reviews | gastroenterology & hepatology volume 6 | oCtoBer 2009 | 561