Early-life UTI linked to higher risk of irritable bowel syndrome

Last Updated: 2018-04-20

By Rita Buckley

NEW YORK (Reuters Health) - Infants with urinary tract infection (UTI) are at higher risk of developing irritable bowel syndrome (IBS) in childhood, researchers suggest.

"This study confirms previous investigations suggesting that UTI early in life predisposes children to develop IBS," Dr. Chang-Ching Wei of the China Medical University Hospital in Taichung, Taiwan, told Reuters Health by email. "Clinicians and researchers should be aware of early symptoms of IBS in children with a past medical history of UTI."

Current management of IBS is limited to treatment once symptoms develop, Dr. Wei and colleagues note in the Journal of Investigative Medicine, online March 26.

"An alternative approach to IBS would be to establish prevention strategies," he said. "To accomplish this change in paradigm we need to start identifying risk factors in the development of IBS."

The researchers conducted a population-based retrospective case-control study comparing more than 31,700 children with a first episode of UTI in 2000-2012 with some 127,000 matched controls. Population-based claims data came from the National Health Insurance program, which covers over 99% of Taiwan's population.

Overall, infants with UTI had a mean age of 5.57 months, 55.8% were boys and 60.7% lived in high-density population areas.

At the end of a 12-year follow-up, the incidence of IBS was 1.52-fold greater in the UTI cohort than in the non-UTI cohort (2.05 vs. 1.32 per 1,000 person-years; P<0.001). Male infants with UTI had a slightly but significantly greater risk for IBS than female infants.

Subsequent risks for IBS in infants with UTI were significantly greater for those with more UTI-related medical visits per year, longer hospitalization and vesicoureteral reflux.

"These results might help explain the pathogenesis and pathophysiology of a subset of children with IBS and develop novel preventive and treatment strategies," Dr. Wei said.

He noted that his team was unable to present information not captured in administrative claims databases, such as genetic and behavioral factors, laboratory data, over-the-counter medication, or medication response.

"The use of an antibiotic in infancy does not seem to be a confounder in our study, though its influence cannot be excluded," Dr. Wei said.

As to the link between UTI and IBS, he speculated, "Possible mechanisms may include cross-organ sensitization of the pelvic organs. The overlapping nervous system connectivity of bladder and colon and other unknown mechanisms should be investigated in future studies."

Dr. Christopher Moran, research director of the Center for Pediatric Inflammatory Bowel Disease at MassGeneral Hospital for Children in Boston, told Reuters Health by email, "I think this data is too early in the stages to affect patient management. Clearly, urinary tract infections in young children merit treatment, and further studies are needed to determine the mechanism of the association."

"It's not clear whether the urinary tract infection itself sensitizes the peripheral nerves and predisposes to irritable bowel syndrome or whether it is antibiotics that cause a fundamental change in the intestinal microbiome that predisposes patients to irritable bowel syndrome. Data in adults suggest this," said Dr. Moran, who was not involved in the study. "The study that they cite arguing against the antibiotic effect is quite small and probably not enough to rule out the effects of antibiotics."

SOURCE: https://bit.ly/2HOe5MF

J Investig Med 2018.