Sequelae of gastrointestinal infections: incidence, risk factors, and economic impact on primary and secondary care settings.

Date of Approval
Application Number
Technical Summary

The purpose of this research is to determine the incidence of sequelae following common GI infections, associated risk factors and the economic impact across primary and secondary healthcare settings. Sequelae of interest include reactive arthritis (ReA) and irritable bowel syndrome (IBS), both commonly diagnosed in primary care; rare complications such as Guillain-Barre Syndrome (GBS), sepsis and Crohn's disease, commonly diagnosed in secondary care; and extraintestinal manifestations such as rheumatoid arthritis. To address this, we will conduct a retrospective cohort study of linked primary care, secondary care, death and deprivation data from 2000-2015 to describe the incidence of sequelae following infection with non-typhoidal Salmonella (NTS) and Campylobacter in England. We will test the hypothesis that use of certain classes of antibiotics (quinolones, macrolides and cephalosporins) and acid-reducing drugs are associated with the development of complications. Additionally, we will quantify resource use and associated costs across healthcare settings. The results from this study will provide more robust estimates of the incidence of sequelae following GI infections, the effect of associated risk factors and the economic burden, thereby informing current strategies to reduce exposure to infection and allocate resources efficiently.

Health Outcomes to be Measured

Reactive Arthritis, Irritable Bowel Syndrome, GP consultations, Laboratory tests, Referrals, Prescriptions, Gastrointestinal hospital admission, Guillain-Barre Syndrome, Sepsis, Rheumatoid arthritis, Crohn's disease, Ulcerative colitis, Inflammatory Bowel Disease, Death


Rafael Perera - Chief Investigator - University of Oxford
Oluwaseun Esan - Corresponding Applicant - University of Oxford
Alastair Gray - Collaborator - University of Oxford
Mara Violato - Collaborator - University of Oxford
Noel McCarthy - Collaborator - Health Protection Agency - HPA
Oluwaseun Esan - Collaborator - University of Oxford
Thomas Fanshawe - Collaborator - University of Oxford


HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation