Bidirectional association between infectious gastroenteritis and inflammatory bowel disease: a population-based study

• Published in: European journal of medical research 2023-09, Vol.28 (1), p.1-337, Article 337
• Main Authors: Tu, Kuan-Chieh, Yu, Ru-Yi, Lin, Yu-Hsuan, Chien, Chih-Chiang, Lu, Chin-Li
• Format: Article
• Language: English
• Subjects: Analysis; Bidirectional association; Cohort analysis; Confounding (Statistics); Crohn’s disease; Epidemiology; Gastroenteritis; Infectious gastroenteritis; Inflammatory bowel disease; Medical records; Medical research; Medical societies; Medicine, Experimental; National health insurance; Patients; Population; Population-based studies; Regression analysis; Socioeconomic factors; Ulcerative colitis; Variables
• ISSN: 2047-783X; 0949-2321; 2047-783X
• DOI: 10.1186/s40001-023-01324-y

Background Intertwined association between infectious gastroenteritis (IGE) and inflammatory bowel disease (IBD) has not been investigated clearly. We aimed to examine the bidirectional association between IGE and IBD. Methods A bidirectional study using the Taiwan National Health Insurance Research Database was designed. Through a case-control design, we identified 2899 new IBD cases during 2006-2017 and matched to 28,990 non-IBD controls. We used conditional logistic regression model to estimate odds ratios (OR) of IBD for previous IGE in different exposure time-windows within 5-years before IBD diagnosis and Poisson regression model to estimate incidence rate ratio (IRR) of subsequent IGE for IBD group to non-IBD group. Results The mean age at the initial IBD diagnosis was 41 years. More IBD patients (21.49%) than controls (12.60%) had been exposed to IGE during > 6 months to 5 years before IBD diagnosis, the OR of IBD for IGE was 1.89 [95% confidence interval: 1.69-2.11]. Excess OR decreased as IGE exposure time before the index date increased. More IGE episodes were associated with additional increase in IBD risk (OR: 1.64, 2.19, 2.57, 3.50, and 4.57 in patients with 1, 2, 3, 4, and [greater than or equal to] 5 IGE episodes, respectively). The IRR of having IGE for IBD group to non-IBD group was 2.42 before IBD diagnosis and increased to 5.74 after IBD diagnosis. Conclusions These findings suggested an IGE-IBD bidirectional association. More attention is needed for physicians to develop preventive strategies and be aware of the higher risk of subsequent IGE in IBD patients. Keywords: Inflammatory bowel disease, Ulcerative colitis, Crohn's disease, Infectious gastroenteritis, Bidirectional association, Epidemiology