Bacterial Gastroenteritis Ups Intussusception Risk

SALT LAKE CITY — A young child who has a bacterial gastrointestinal infection may have a 30 times higher risk of intussusception in the following 6 months, according to a study of cases from a large military database.

“There is a significant increased risk of intussusception in patients with a recent gastrointestinal infection,” said Capt. Cade M. Nylund, MC, USAF, at the annual meeting of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.

The potential association between bacterial gastroenteritis and intussusception had not been investigated before, although there had been case reports, Dr. Nylund said. He was prompted to look into the possibility of an association by the case of a 17-month-old girl with an intussusception who had had bloody diarrhea 2 weeks previously.

He searched the military's Patient Administration System and Biostatistics Activity database for all children 5 years old or younger who were seen with bacterial gastroenteritis at a military medical facility between January 2002 and December 2005. The search was conducted to find an ICD diagnostic-related group (DRG) code specifically for infection with Yersinia enterocolitica, Escherichia coli, Campylobacter, Shigella species, and Salmonella species.

Dr. Nylund, of the San Antonio Military Pediatric Center, also searched the records for a DRG code or a current procedural terminology code for an intussusception within 6 months after the infection.

He reviewed 387,514 persons, in which there were 1,412 infections and 293 intussusceptions. The overall rate for intussusception in the reviewed patients, therefore, was 7.6 cases per 10,000 population, a rate that is consistent with previous population reports, Dr. Nylund said. Of the 293 intussusception cases, 37 were in patients who had been seen for bacterial gastroenteritis in the previous 6 months.

The analysis showed that the odds ratio for a case of intussusception in those with a previous bacterial gastrointestinal infection was 40. The increase in absolute risk was 30, he said.

The odds ratio in infants less than 1 year of age was 16, and the odds ratio for children between 1 year and 5 years was 56.

The organism with the most frequent association was Salmonella, which accounted for 18 of the cases and had an odds ratio of 46. The second most frequent association was with E. coli, which accounted for 12 cases and had an odds ratio of 33.

Five cases were associated with a Shigella infection and two with a Campylobacter infection.

No cases were associated with a Yersinia infection, but that may have been because it was so rare; the database included only four cases of Yersinia infection.

Most of the intussusceptions occurred within 8 days of the infection, although some occurred months afterward. Dr. Nylund said it was not possible to know whether there was increased risk beyond 6 months, because he looked only for an association within 6 months, a period of time he chose arbitrarily.

The association between infection and intussusception could be related to hyperplasia caused by the infection, or could be linked to changes in motility, he said.

SALT LAKE CITY — A young child who has a bacterial gastrointestinal infection may have a 30 times higher risk of intussusception in the following 6 months, according to a study of cases from a large military database.

“There is a significant increased risk of intussusception in patients with a recent gastrointestinal infection,” said Capt. Cade M. Nylund, MC, USAF, at the annual meeting of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.

The potential association between bacterial gastroenteritis and intussusception had not been investigated before, although there had been case reports, Dr. Nylund said. He was prompted to look into the possibility of an association by the case of a 17-month-old girl with an intussusception who had had bloody diarrhea 2 weeks previously.

He searched the military's Patient Administration System and Biostatistics Activity database for all children 5 years old or younger who were seen with bacterial gastroenteritis at a military medical facility between January 2002 and December 2005. The search was conducted to find an ICD diagnostic-related group (DRG) code specifically for infection with Yersinia enterocolitica, Escherichia coli, Campylobacter, Shigella species, and Salmonella species.

Dr. Nylund, of the San Antonio Military Pediatric Center, also searched the records for a DRG code or a current procedural terminology code for an intussusception within 6 months after the infection.

He reviewed 387,514 persons, in which there were 1,412 infections and 293 intussusceptions. The overall rate for intussusception in the reviewed patients, therefore, was 7.6 cases per 10,000 population, a rate that is consistent with previous population reports, Dr. Nylund said. Of the 293 intussusception cases, 37 were in patients who had been seen for bacterial gastroenteritis in the previous 6 months.

The analysis showed that the odds ratio for a case of intussusception in those with a previous bacterial gastrointestinal infection was 40. The increase in absolute risk was 30, he said.

The odds ratio in infants less than 1 year of age was 16, and the odds ratio for children between 1 year and 5 years was 56.

The organism with the most frequent association was Salmonella, which accounted for 18 of the cases and had an odds ratio of 46. The second most frequent association was with E. coli, which accounted for 12 cases and had an odds ratio of 33.

Five cases were associated with a Shigella infection and two with a Campylobacter infection.

No cases were associated with a Yersinia infection, but that may have been because it was so rare; the database included only four cases of Yersinia infection.

Most of the intussusceptions occurred within 8 days of the infection, although some occurred months afterward. Dr. Nylund said it was not possible to know whether there was increased risk beyond 6 months, because he looked only for an association within 6 months, a period of time he chose arbitrarily.

The association between infection and intussusception could be related to hyperplasia caused by the infection, or could be linked to changes in motility, he said.

SALT LAKE CITY — A young child who has a bacterial gastrointestinal infection may have a 30 times higher risk of intussusception in the following 6 months, according to a study of cases from a large military database.

“There is a significant increased risk of intussusception in patients with a recent gastrointestinal infection,” said Capt. Cade M. Nylund, MC, USAF, at the annual meeting of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.

The potential association between bacterial gastroenteritis and intussusception had not been investigated before, although there had been case reports, Dr. Nylund said. He was prompted to look into the possibility of an association by the case of a 17-month-old girl with an intussusception who had had bloody diarrhea 2 weeks previously.

He searched the military's Patient Administration System and Biostatistics Activity database for all children 5 years old or younger who were seen with bacterial gastroenteritis at a military medical facility between January 2002 and December 2005. The search was conducted to find an ICD diagnostic-related group (DRG) code specifically for infection with Yersinia enterocolitica, Escherichia coli, Campylobacter, Shigella species, and Salmonella species.

Dr. Nylund, of the San Antonio Military Pediatric Center, also searched the records for a DRG code or a current procedural terminology code for an intussusception within 6 months after the infection.

He reviewed 387,514 persons, in which there were 1,412 infections and 293 intussusceptions. The overall rate for intussusception in the reviewed patients, therefore, was 7.6 cases per 10,000 population, a rate that is consistent with previous population reports, Dr. Nylund said. Of the 293 intussusception cases, 37 were in patients who had been seen for bacterial gastroenteritis in the previous 6 months.

The analysis showed that the odds ratio for a case of intussusception in those with a previous bacterial gastrointestinal infection was 40. The increase in absolute risk was 30, he said.

The odds ratio in infants less than 1 year of age was 16, and the odds ratio for children between 1 year and 5 years was 56.

The organism with the most frequent association was Salmonella, which accounted for 18 of the cases and had an odds ratio of 46. The second most frequent association was with E. coli, which accounted for 12 cases and had an odds ratio of 33.

Five cases were associated with a Shigella infection and two with a Campylobacter infection.

No cases were associated with a Yersinia infection, but that may have been because it was so rare; the database included only four cases of Yersinia infection.

Most of the intussusceptions occurred within 8 days of the infection, although some occurred months afterward. Dr. Nylund said it was not possible to know whether there was increased risk beyond 6 months, because he looked only for an association within 6 months, a period of time he chose arbitrarily.

The association between infection and intussusception could be related to hyperplasia caused by the infection, or could be linked to changes in motility, he said.