Probability of sequelae following Campylobacter spp. infections: Update of systematic reviews and meta-analyses

Abstract

Introduction: Reactive arthritis (REA) and Guillain-Barré syndrome (GBS) are postinfectious complications of Campylobacter enteritis (CE); associations with inflammatory bowel diseases and irritable bowel syndrome (IBS) are also discussed. The objective of this study was to summarize existing evidence on the probability of sequelae following confirmed CE.

Methods: All studies included in previous reviews and meta-analyses on this topic were retrieved and assessed for eligibility; a systematic literature search was conducted to collect more recent reports. For each sequela, random effects meta-analyses were performed; the risk of bias and the quality of evidence were evaluated.

Results: In total, 50 reports of observational studies were included; between 110,765 and 175,839 CE cases were considered for each sequela. The pooled proportion of CE cases that developed a sequela was 1.72% (95% CI 0.81-3.61; prediction interval [PI]: 0.03-47.65) for REA, 0.07% (0.03-0.16; PI: 0.003-1.59) for GBS, 0.22% (0.06-0.73; PI: 0.002-20.69) for Crohn's disease (CD), 0.35% (0.11-1.15; PI: 0.003-28.16) for ulcerative colitis (UC), and 4.48% (1.92-10.08; PI: 0.09-70.62) for IBS. The high between-study heterogeneity could partially be explained by study size and design, the method of assessing sequelae, and the period between CE and sequelae onset. The quality of evidence was rated as moderate for GBS and UC, and low for REA, CD, and IBS.

Conclusion: Updated estimates of the probability to develop sequelae after CE are provided, for CD and UC for the first time. However, uncertainty regarding the true probabilities remains, which is reflected in the broad PIs.

Keywords: Campylobacter infections; Guillain–Barré syndrome; arthritis, reactive; inflammatory bowel diseases; irritable bowel syndrome; meta‐analysis.

FIGURE 1

Preferred reporting items for systematic reviews and meta‐analyses (PRISMA) flow chart showing the study selection process. CD, Crohn's disease; CE, Campylobacter enteritis; GBS, Guillain–Barré syndrome; IBD, inflammatory bowel disease; IBS, irritable bowel syndrome; REA, reactive arthritis; UC, ulcerative colitis.

FIGURE 2

Forest plot of studies reporting the proportion of Campylobacter enteritis (CE) cases that developed reactive arthritis (REA), stratified by follow‐up period. The results of all subgroup analyses are displayed in the Supporting Information Appendix.

FIGURE 3

Forest plot of studies reporting the proportion of Campylobacter enteritis (CE) cases that developed Guillain–Barré syndrome (GBS), stratified by study size. The results of all subgroup analyses are displayed in the Supporting Information Appendix.

FIGURE 4

Forest plot of studies reporting the proportion of Campylobacter enteritis (CE) cases that developed inflammatory bowel diseases: (A) Crohn's disease (CD), (B) ulcerative colitis (UC).

FIGURE 5

Forest plot of studies reporting the proportion of Campylobacter enteritis (CE) cases that developed irritable bowel syndrome (IBS), stratified by sequelae diagnosis. The results of all subgroup analyses are displayed in the Supporting Information Appendix.