Gastroenterology

Gastroenterology

Volume 129, Issue 1, July 2005, Pages 98-104
Gastroenterology

Clinical-alimentary tract
Dyspepsia and Irritable Bowel Syndrome After a Salmonella Gastroenteritis Outbreak: One-Year Follow-up Cohort Study

https://doi.org/10.1053/j.gastro.2005.04.012Get rights and content

Background & Aims: It has been reported that some patients develop functional digestive disorders, particularly irritable bowel syndrome (IBS), after acute gastroenteritis (AGE). However, the presence of dyspepsia has not been specifically addressed. We prospectively evaluated development of dyspepsia and IBS during a 1-year follow-up in a cohort of adult patients affected by a Salmonella enteritidis AGE outbreak. Methods: Questionnaires were sent to 1878 potential participants at baseline and 3, 6, and 12 months; 677 had experienced a Salmonella enteritidis AGE on June 23, 2002, and 1201 had not (randomly selected controls, matched for village of residence, age, and sex). At 12 months, 271 patients and 335 controls returned the questionnaires. Data permitted the establishment of dyspepsia and IBS diagnosis by Rome II criteria. Results: Before the AGE outbreak, the prevalence of dyspepsia was similar in cases and controls (2.5% vs 3.8%); the prevalence of IBS was also similar (2.9% vs 2.3%). At 3, 6, and 12 months, the prevalence of both dyspepsia and IBS had increased significantly in exposed compared with unexposed subjects. Overlap between dyspepsia and IBS was frequent. At 1 year, the relative risk for development of dyspepsia was 5.2 (95% confidence interval, 2.7–9.8) and for IBS was 7.8 (95% confidence interval, 3.1–19.7). Prolonged abdominal pain and vomiting during AGE were positive predictors of dyspepsia. No predictive factors for IBS were found. Conclusions: Salmonella gastroenteritis is a significant risk factor not only for IBS but also for dyspepsia; at 1 year of follow-up, 1 in 7 and 1 in 10 subjects developed dyspepsia or IBS, respectively.

Section snippets

Study Design

On June 23, 2002, an outbreak of AGE occurred in a Spanish village of 9004 inhabitants (Torroella de Mongrí) located in the Baix Empordà county (Catalonia) with 106,828 inhabitants. The cause was S enteritidis colonization of traditional cream cakes, all made in the same baker’s shop to celebrate Saint John’s Eve. A total of 1243 persons were affected; about 40% were Torroella residents, 40% from other villages of the same county, and 20% visitors. Information with demographic (name, age, sex,

Results

Demographic and clinical data at study entry are shown in Table 1. Almost all (96.1%) of the patients with AGE had eaten the infected cake; the origin of the infection in the remainder could have been interpersonal or another product from the same bakery also containing Salmonella. In the control group, 6.8% of subjects reported having eaten some type of cake bought at the same bakery where the infected cake was made.

The prevalence of dyspepsia before AGE was similar in patients and controls

Discussion

Several previous studies related AGE to development of IBS. Between 6% and 17% of patients attributed their IBS to an attack of gastroenteritis.6 Prospective investigations also found an increase in the prevalence of IBS after AGE, but data vary depending on the severity of the infection (ambulatory or hospitalized patients) and infectious agent (with Campylobacter and Shigella carrying more risk than S enteritidis). Moreover, in prospective studies, no control group was included to ascertain

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    Supported in part by Grupo Menarini Spain and supported by grant PI042739 from Fondo de Investigaciones Sanitarias, Ministerio de Sanidad y Consumo, Spain.

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