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Assessing the Risk of Irritable Bowel Syndrom One Year Post-Acute Gastroenteritis

Kowalcyk, Barbara B.

Abstract Details

2011, PhD, University of Cincinnati, Medicine: Epidemiology (Environmental Health).

Introduction: Acute gastroenteritis (GE) is an important cause of morbidity and mortality worldwide, particularly for children. Several studies have associated GE, which may have a foodborne etiology, with the development of irritable bowel syndrome (IBS). Understanding the incidence of GE, and its association with IBS and functional bowel disease (FBD), will improve the clinical management of patients and provide policy makers with better burden of disease estimates.

Aims: The aim of this prospective cohort study is to estimate the incidence of GE, IBS and FBD, estimate the relative risk of IBS one year post-GE and explore potential risk factors for IBS among primary care practices in the Netherlands from 1998 to 2009.

Methods: Data from the Primary Care Network Utrecht (PCNU), a prospective cohort with routine consultation data for more than 60,000 patients annually, were used for the analysis. The annual incidence of GE and IBS consultations were estimated and temporal trends were evaluated. Patients, aged 18 to 70 years, with gastrointestinal infection or diarrhea and at least one year of data recorded in the PCNU electronic databases were included in the GE cohort. Patients with a history of cancer, alcohol abuse, GE symptoms in the prior 12 months, pre-existing IBS/FBD diagnosis or abdominal surgery or 5 or more prescriptions associated with IBS or FBD treatment were excluded. Patients consulting for non-IBS related medical reasons, matched by age, gender, consulting practice and time of visit, were randomly selected for the control cohort. The prevalence of IBS during follow-up was compared in the GE and control cohort.

Results: In total, 23,451 patients consulted their physician for at least one GE-related event between 1998 and 2009. During the same time period, 4,980 patients consulted the PCNU for IBS. Temporal trends were fairly consistent across health outcomes with a decreasing trend in incidence from 1998 to 2005, at which point the trend reversed and started to increase. Notably, using a medical registration system that requires a diagnostic code greatly increased the estimated incidence of GE, IBS and FBD. To assess the relative risk of IBS following acute gastroenteritis, 6,173 patients who consulted their physician for at least one GE-related event during the study period and met the inclusion/exclusion criteria were matched to a comparison cohort of 5,967 patients. Patients with GE had an increased risk of IBS (relative risk: 9.71; 95% CI: 6.14, 15.36). Female gender, cramps with illness, healthcare seeking behaviors, consulting practice and year of diagnosis were significantly associated with IBS in GE patients. Similar results were seen for functional bowel disease and when using different definitions for GE.

Conclusions: GE and IBS are a significant burden in the Netherlands. Patients diagnosed with acute gastroenteritis in primary care have an increased risk of IBS at one year follow-up compared to their matched controls. Given the importance of understanding disease trends over time and the impact that electronic registration systems can have on the estimated incidences, additional research is needed to determine if recent trends in GE and IBS consultations are due to true increases in disease or are an artefact of the registration system used. Additional studies are also needed to determine the risk of IBS following GE in the general population.

Paul Succop, PhD (Committee Chair)
Arie Havelaar, PhD (Committee Member)
Craig Hedberg, PhD (Committee Member)
Stephen Kralovic, MD (Committee Member)
121 p.

Recommended Citations

Citations

  • Kowalcyk, B. B. (2011). Assessing the Risk of Irritable Bowel Syndrom One Year Post-Acute Gastroenteritis [Doctoral dissertation, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1320173759

    APA Style (7th edition)

  • Kowalcyk, Barbara. Assessing the Risk of Irritable Bowel Syndrom One Year Post-Acute Gastroenteritis. 2011. University of Cincinnati, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1320173759.

    MLA Style (8th edition)

  • Kowalcyk, Barbara. "Assessing the Risk of Irritable Bowel Syndrom One Year Post-Acute Gastroenteritis." Doctoral dissertation, University of Cincinnati, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1320173759

    Chicago Manual of Style (17th edition)