Schorling Elisabeth, Knorr Sebastian, Lick Sonja, Steinberg Pablo, Brüggemann Dagmar Adeline
Department of Safety and Quality of Meat Max Rubner-Institut, Federal Research Institute of Nutrition and Food Kulmbach Bavaria Germany.
Max Rubner-Institut, Federal Research Institute of Nutrition and Food Karlsruhe Baden-Wurttemberg Germany.
Public Health Chall. 2023 Dec 20;2(4):e145. doi: 10.1002/puh2.145. eCollection 2023 Dec.
Reactive arthritis (REA) and Guillain-Barré syndrome (GBS) are postinfectious complications of enteritis (CE); associations with inflammatory bowel diseases and irritable bowel syndrome (IBS) are also discussed. The objective of this study was to summarize existing evidence on the probability of sequelae following confirmed CE.
All studies included in previous reviews and meta-analyses on this topic were retrieved and assessed for eligibility; a systematic literature search was conducted to collect more recent reports. For each sequela, random effects meta-analyses were performed; the risk of bias and the quality of evidence were evaluated.
In total, 50 reports of observational studies were included; between 110,765 and 175,839 CE cases were considered for each sequela. The pooled proportion of CE cases that developed a sequela was 1.72% (95% CI 0.81-3.61; prediction interval [PI]: 0.03-47.65) for REA, 0.07% (0.03-0.16; PI: 0.003-1.59) for GBS, 0.22% (0.06-0.73; PI: 0.002-20.69) for Crohn's disease (CD), 0.35% (0.11-1.15; PI: 0.003-28.16) for ulcerative colitis (UC), and 4.48% (1.92-10.08; PI: 0.09-70.62) for IBS. The high between-study heterogeneity could partially be explained by study size and design, the method of assessing sequelae, and the period between CE and sequelae onset. The quality of evidence was rated as moderate for GBS and UC, and low for REA, CD, and IBS.
Updated estimates of the probability to develop sequelae after CE are provided, for CD and UC for the first time. However, uncertainty regarding the true probabilities remains, which is reflected in the broad PIs.
反应性关节炎（REA）和吉兰 - 巴雷综合征（GBS）是肠炎（CE）的感染后并发症；本文还讨论了它们与炎症性肠病和肠易激综合征（IBS）的关联。本研究的目的是总结关于确诊CE后出现后遗症可能性的现有证据。
检索并评估了先前关于该主题的综述和荟萃分析中纳入的所有研究，进行了系统的文献检索以收集更新的报告。对每种后遗症进行随机效应荟萃分析，评估偏倚风险和证据质量。
总共纳入了50篇观察性研究报告；每种后遗症考虑了110,765至175,839例CE病例。发生REA后遗症的CE病例合并比例为1.72%（95%可信区间[CI] 0.81 - 3.61；预测区间[PI]：0.03 - 47.65），GBS为0.07%（0.03 - 0.16；PI：0.003 - 1.59），克罗恩病（CD）为0.22%（0.06 - 0.73；PI：0.002 - 20.69），溃疡性结肠炎（UC）为0.35%（0.11 - 1.15；PI：0.003 - 28.16），IBS为4.48%（1.92 - 10.08；PI：0.09 - 70.62）。研究间的高异质性部分可由研究规模和设计、评估后遗症的方法以及CE与后遗症发病之间的时间间隔来解释。GBS和UC的证据质量评为中等，REA、CD和IBS的证据质量评为低等。
首次提供了CE后发生后遗症概率的更新估计值，包括CD和UC。然而，真实概率仍存在不确定性，这在宽泛的预测区间中有所体现。
