Department of Medical and Surgical Sciences, University of Bologna, Italy.
Department of Medical and Surgical Sciences, University of Bologna, Italy.
Gastroenterology. 2014 Jul;147(1):69-77. doi: 10.1053/j.gastro.2014.03.013. Epub 2014 Mar 20.
BACKGROUND & AIMS: Acute infectious gastroenteritis increases the risk for irritable bowel syndrome (IBS) and functional dyspepsia (FD). Children are particularly vulnerable to gastroenteritis because of the immaturity of their intestinal barrier, enteric nervous system, and immune response to pathogens. We investigated whether acute gastroenteritis in early life increases the risk of IBS and FD throughout adulthood.
In 1994, we identified and monitored a single culture-proven foodborne Salmonella enteritidis outbreak that involved 1811 patients (mostly pediatric) in Bologna, Italy. Clinical data were collected and a prospective, controlled, cohort study was designed. Long-term effects were assessed by mailing a questionnaire to 757 subjects 16 years after the outbreak (when all of the children were adults). We randomly selected a cohort of 250 adults exposed to Salmonella as children, all 127 individuals exposed as adults, and a cohort of nonexposed participants matched for number, age, sex, and area of residence (controls).
Among 198 exposed participants, 64 reported FD (32.3%), compared with 51 of 188 controls (27.1%; P = .268). Among 204 exposed participants, 75 reported having IBS (36.8%) compared with 44 of 189 controls (23.3%; P = .004). The odds ratio for IBS among people exposed to the Salmonella was 1.92 (95% confidence interval: 1.23-2.98). The prevalence of IBS was higher in individuals exposed Salmonella as children than in controls (35.3% vs 20.5%; P = .008), but not in individuals exposed as adults, compared with controls. After multivariate logistic regression, post-infectious IBS was independently associated with anxiety and FD.
Based on data collected from a single culture-proven foodborne Salmonella enteritidis outbreak in 1994, Salmonella-induced gastroenteritis during childhood (but not adulthood) is a risk factor for IBS.
急性感染性胃肠炎会增加肠易激综合征（IBS）和功能性消化不良（FD）的风险。由于儿童的肠道屏障、肠神经系统和对病原体的免疫反应不成熟，他们尤其容易受到胃肠炎的影响。我们研究了儿童时期的急性胃肠炎是否会增加成年后患 IBS 和 FD 的风险。
1994 年，我们在意大利博洛尼亚鉴定并监测了一起由单一致病菌食源性肠炎沙门氏菌引起的、涉及 1811 名患者（主要是儿科患者）的暴发事件。我们收集了临床数据并设计了前瞻性、对照队列研究。通过向暴发事件 16 年后的 757 名受试者邮寄问卷来评估长期影响（此时所有儿童均已成年）。我们随机选择了一组 250 名儿童时期暴露于沙门氏菌的成年人、所有 127 名成年时期暴露于沙门氏菌的个体以及一组与数量、年龄、性别和居住地相匹配的未暴露参与者（对照组）。
在 198 名暴露参与者中，64 名报告患有 FD（32.3%），而 188 名对照组中 51 名（27.1%；P=.268）。在 204 名暴露参与者中，75 名报告患有 IBS（36.8%），而 189 名对照组中 44 名（23.3%；P=.004）。暴露于沙门氏菌的个体患 IBS 的比值比为 1.92（95%置信区间：1.23-2.98）。与对照组相比，儿童时期暴露于沙门氏菌的个体中 IBS 的患病率更高（35.3% vs 20.5%；P=.008），但在成年时期暴露于沙门氏菌的个体中与对照组相比则没有差异。多变量逻辑回归后，感染后 IBS 与焦虑和 FD 独立相关。
基于 1994 年一起经培养证实的食源性肠炎沙门氏菌暴发事件的数据，儿童时期的沙门氏菌诱导性胃肠炎（而非成年时期）是 IBS 的一个危险因素。
