Risk for high blood pressure, kidney and cardiovascular disease can persist long after E. coli gastroenteritis

Research just published in the British Medical Journal presents another example of acute gastrointestinal infection triggering chronic inflammation that persists long after the infection has subsided. The authors set out to...

"...evaluate the risk for hypertension, renal impairment, and cardiovascular disease within eight years of gastroenteritis from drinking water contaminated with Escherichia coli O157:H7 and Campylobacter."

They followed 1977 adult participants, 1067 of whom came down with acute gastroenteritis when a municipal water system was contaminated. None of them had a history of the subsequent diseases they were looking for which included hypertension (blood pressure ≥140/90 mm Hg), kidney impairment (microalbuminuria or estimated glomerular filtration rate <60 ml/min/1.73 m2), and cardiovascular disease (heart attack, stroke, or congestive heart failure). What did the data show?

"The adjusted hazard ratios for hypertension and cardiovascular disease after acute gastroenteritis were 1.33 and 2.13 respectively. The adjusted hazard ratio for the presence of either indicator of renal impairment was 1.15 and was 3.41 for the presence of both."

In other words, having a case of acute gastroenteritis resulted in a later increase of 33% in the risk for high blood pressure, 213% for cardiovascular disease, and a whopping 341% for a combination of the two indicators of kidney impairment (microalbuminuria and lower glomerular filtration rate). Thus the authors conclude:

"Acute gastroenteritis from drinking water contaminated with E coli O157:H7 and Campylobacter was associated with an increased risk for hypertension, renal impairment, and self reported cardiovascular disease...Our findings underline the need for following up individual cases of food or water poisoning by E coli O157:H7 to prevent or reduce silent progressive vascular injury...annual blood pressure monitoring and periodic monitoring of renal function may be warranted for individuals who experience acute gastroenteritis after exposure to food or water contaminated with E coli O157:H7."

This is another example of how GI infections can trigger the long-term immune system dysregulation that promotes chronic inflammation, the biological basis of cardiovascular disease and renal impairment. Clinicians should be diligent in diagnosing GI infection and astute in examining for immune dysfunction and occult autoimmune disorders.