Increased Risk of Functional Gastrointestinal Sequelae Following Clostridium difficile infection among Active Duty United States Military Personnel (1998-2010)

Gutiérrez RL1, Riddle MS2, Porter CK2. Gastroenterology. 2015 Aug 6. pii: S0016-5085(15)01091-4. doi: 10.1053/j.gastro.2015.07.059. [Epub ahead of print]
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1Enteric Diseases Department, Naval Medical Research Center, Silver Spring, Maryland. Electronic address: ramiro.l.gutierrez.mil@mail.mil. 2Enteric Diseases Department, Naval Medical Research Center, Silver Spring, Maryland.


BACKGROUND & AIMS: Some acute enteric infections are associated with development of functional gastrointestinal disorders, most commonly irritable bowel syndrome, but also other functional and organic gastrointestinal sequelae. Clostridium difficile infection has increased in incidence and severity, yet few studies have evaluated functional disorders after this infection.

METHODS: We evaluated the epidemiology and sequelae of C.difficile in the US military populationby using the US Department of Defense's Armed Forces Health Surveillance Center medical encounter database. We then performed a retrospective cohort study of 891 active duty US military personnel who developed C. difficile from 1998-2010 and 3231 matched subjects who had not been exposed to C.difficile. Subjects were identified based on ICD-9CM codes for C.difficile disease.

RESULTS: C.difficile was independently associated with increased relative risks (RR) for incident irritable bowel syndrome (RR, 6.1; 95% confidence interval [CI], 2.9-12.9), gastroesophageal reflux disease (RR, 1.9; 95% CI, 1.4-2.6), dyspepsia (RR, 3.3; 95%, 1.4-7.7), and constipation (RR, 2.2; 95% CI, 1.3-3.7). Approximately 14.1% of subjects with C.difficile were later identified with one of these FGDs, compared to 6% of controls. Community and healthcare associated-C.difficile were associated at similar rates with these sequelae. Patients were at increased risk for FGDs within 3 months of a C. difficile episode, with one additional case of FGD developed for every 12 diagnoses of C. difficile.

CONCLUSIONS: The incidence of community and healthcare associated-C.difficile has increased in the US military population from 1998 through 2010. As for other gastrointestinal infections, C. difficile disease is associated with clinically relevant functional sequelae in this military population.

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