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An Outbreak of Acute Bacterial Gastroenteritis Is Associated With an Increased Incidence of Irritable Bowel Syndrome in Children

Am J Gastroenterol advance online publication 23 February 2010; doi: 10.1038/ajg.2010.74 – Marroon Thabane MSc1,2, Marko Simunovic MD, MSc, FRCPC2,3, Noori Akhtar-Danesh PhD2,4, Amit X Garg MD, PhD, FRCPC2,5, William F Clark MD, FRCPC5, Stephen M Collins MD, FRCPC1, Marina Salvadori MD, FRCPC5 and John K Marshall MD, MSc, FRCPC, AGAF1,2

OBJECTIVES:

Acute bacterial gastroenteritis is associated with subsequent post-infectious irritable bowel syndrome (PI-IBS) in adults. Less is known about this relationship in children. In May 2000, contamination of municipal water by Escherichia coli 0157:H7 and Campylobacter species caused a large outbreak of acute gastroenteritis in Walkerton, Ontario. We assessed this association among a cohort of children enrolled in the Walkerton Health Study (WHS).

METHODS:

WHS participants who were under age 16 at the time of the outbreak but who reached age 16 during the 8-year study follow-up were eligible for the pediatric PI-IBS study cohort. Eligibility also required no diagnosis of IBS or inflammatory bowel disease before the outbreak and permanent residency in the Walkerton postal code at the time of the outbreak. Validated criteria were used to classify subjects as having had no gastroenteritis (unexposed controls), self-reported gastroenteritis, or clinically suspected gastroenteritis during the outbreak. From 2002 to 2008, standardized biennial interviews used a modified Bowel Disease Questionnaire to diagnose IBS by Rome I criteria. Risk factors for IBS were identified by logistic regression.

RESULTS:

In all, 467 subjects were eligible for the pediatric PI-IBS study cohort (47.1% female; mean age 11.6±2.44 years at the time of the outbreak). Of these, 305 were exposed to GE (130 clinically suspected and 175 self-reported) and 162 were unexposed controls. The cumulative incidence of IBS was significantly increased among exposed subjects vs. controls (10.5% vs. 2.5%; odds ratio 4.6, 95% confidence interval (1.6, 13.3)). In an unadjusted risk factor analysis, IBS was associated with a shorter time interval from exposure to assessment of IBS symptoms, female gender, diarrheal illness lasting more than 7 days, weight loss >10 lb, and antibiotic use during the outbreak. In adjusted analyses, both female gender and time interval to assessment of IBS symptoms remained independent predictors of PI-IBS.

CONCLUSIONS:

Acute bacterial gastroenteritis is associated with subsequent IBS in children as in adults. Risk factors for PI-IBS in children are similar to those identified among adults. Confirmation of these findings in similar cohorts is needed.

1. Division of Gastroenterology, Department of Medicine, and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
2. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
3. Department of Surgery, McMaster University, Hamilton, Ontario, Canada
4. School of Nursing, McMaster University, Hamilton, Ontario, Canada
5. Division of Nephrology, Department of Medicine, University of Western Ontario, London, Ontario, Canada