Abstract

Gastrointestinal Infection Increases Odds of Inflammatory Bowel Disease in a Nationwide Case-Control Study

Axelrad JE1, Olén O2, Askling J3, Lebwohl B4, Khalili H5, Sachs MC3, Ludvigsson JF6. Clin Gastroenterol Hepatol. 2018 Oct 30. pii: S1542-3565(18)31025-5. doi: 10.1016/j.cgh.2018.09.034. [Epub ahead of print]
 
     

Author information

1 Inflammatory Bowel Disease Center, Division of Gastroenterology, Department of Medicine, NYU Langone Health, New York, New York; Division of Digestive and Liver Disease, Department of Medicine, Columbia University Medical Center, New York, New York. Electronic address: Jordan.Axelrad@nyumc.org.

2 Sachs' Children and Youth Hospital, Stockholm South General Hospital, Stockholm, Sweden; Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.

3 Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.

4 Division of Digestive and Liver Disease, Department of Medicine, Columbia University Medical Center, New York, New York.

5 Inflammatory Bowel Disease Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.

6 Division of Digestive and Liver Disease, Department of Medicine, Columbia University Medical Center, New York, New York; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden; Department of Pediatrics, Orebro University Hospital, Orebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, UK.

Abstract

BACKGROUND & AIMS: Gastrointestinal infections have been associated with later development of inflammatory bowel diseases(IBD). However, studies have produced conflicting results. We performed a nationwide case-control study in Sweden to determine whether gastroenteritis is associated with the development of Crohn's disease (CD) or ulcerative colitis (UC).

METHODS: Using the Swedish National Patient Register, we identified 44,214 patients with IBD (26,450 with UC; 13,387 with CD; and 4,377 with IBD-unclassified) from 2002 to 2014 and matched them with 436,507 individuals in the general population (controls). We then identified patients and controls with reported episodes of gastroenteritis (from 1964 to 2014) and type of pathogen associated. We collected medical and demographic data and used logistic regression to estimate odds ratios (ORs) for IBD associated with enteric infection.

RESULTS: Of the patients with IBD, 3105 (7.0%) (1672 with UC, 1050 with CD, and 383 with IBD-unclassified) had a record of previous gastroenteritis compared with 17,685 controls (4.1%). IBD cases had higher odds for an antecedent episode of gastrointestinal infection (aOR, 1.64; 1.57-1.71), bacterial gastrointestinal infection (aOR, 2.02; 1.82-2.24), parasitic gastrointestinal infection (aOR, 1.55; 1.03-2.33), and viral gastrointestinal infection (aOR, 1.55; 1.34-1.79). Patients with UC had higher odds of previous infection with Salmonella, Escherichia coli, Campylobacter, or Clostridium difficile compared to controls. Patients with CD had higher odds of previous infection with Salmonella, Campylobacter, Yersinia enterocolitica, Clostridium difficile, amoeba, or norovirus compared to controls. Increasing numbers of gastroenteritis episodes were associated with increased odds of IBD, and a previous episode of gastroenteritis was significant associated with odds for IBD more than 10 years later (aOR, 1.26; 1.19-1.33).

CONCLUSION: In an analysis of the Swedish National Patient Register, we found previous episodes of gastroenteritis to increase odds of later development of IBD. Although we cannot formally exclude misclassification bias, enteric infections might induce microbial dysbiosis that contributes to the development of IBD in susceptible individuals.

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