Background & Aims: Bacterial intestinal infections have been implicated as a possible cause of exacerbation of inflammatory bowel disease (IBD). We explored the relationship between infectious gastroenteritis and the occurrence of IBD using data from the General Practice Research Database. Methods: A cohort of patients aged 20–74 years with an episode of acute infectious gastroenteritis (n = 43,013) was identified. From the same source population, an age-, sex-, and calendar time-matched control group free of gastroenteritis was sampled (n = 50,000). Both cohorts were followed up for a mean duration of 3.5 years. Results: The estimated incidence rate of IBD was 68.4 per 100,000 person-years after an episode of gastroenteritis and 29.7 per 100,000 person-years in the control cohort. The hazard ratio of IBD was 2.4 (95% confidence interval [CI], 1.7–3.3) in the gastroenteritis cohort compared with the control cohort, and the excess risk was greater during the first year after the infective episode (hazard ratio, 4.1; 95% CI, 2.2–7.4). The relative risk of developing Crohn’s disease in the gastroenteritis cohort was greater than that of ulcerative colitis, especially during the first year after the infective episode (hazard ratio, 6.6; 95% CI, 1.9–22.4). Conclusions: Our results are compatible with the hypothesis that infectious agents causing an episode of infectious gastroenteritis could play a role in the initiation and/or exacerbation of IBD.

Our source population came from the General Practice Research Database, which contains clinicalinformation on patients recorded by general practitioners in the United Kingdom.4

APPROXIMATELY 30 million patients worldwide take nonsteroidal anti-inflammatory drugs (NSAIDs) every day. In addition to their anti-inflammatory and analgesic effects, NSAIDs have unwanted effects on the upper gastrointestinal tract, mainly by inhibition of the enzyme cyclooxygenase (COX).¹ The gastroduodenal injury ranges from dyspepsia to fatal upper gastrointestinal tract bleeding (UGIB) and perforation. Many epidemiologic studies have shown that NSAIDs increase the risk of peptic ulcer bleeding 3- to 5-fold.^2,3 Ketorolac tromethamine is an NSAID that has attracted the attention of a number of regulatory bodies after the reporting of fatal cases of gastrointestinal tract bleeding.⁴ A recent meta-analysis assessed the relative risk (RR) of UGIB associated with individual NSAIDs⁵; however, the effect of ketorolac could not be analyzed because of lack of information in the original studies.