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BEHANDLING-God og treffsikker diagnostikk, behandling og rehabilitering

Irritable bowel syndrome and chronic fatigue following infection with Giardia lamblia. Premorbid factors and long-term consequences.

Alternative title: null

Awarded: NOK 3.1 mill.

Work related incapacity among Giardia-patients before and after the Giardia outbreak in Bergen 2004. The project is based on the data collected three years after the outbreak, where we found that 46% of the patients had irritable bowel syndrome and 46% had chronic fatigue. The prevalence of these complications were more than three times higher compared to controls without previous giardiasis. By merging these results with data from the official registry on sickness absence and disability pension (FD-Trygd) we will explore whether those who fell sick and later suffered post-infectious complications had more health related loss of function prior to the outbreak. Mental health problems and adverse life experiences are more common among patients with irritable bowel syndrome and chronic fatigue. In this study sickness absence is used as a proxy for vulnerability, and we will investigate if there are differences between the groups. We will also investigate whether the high prevalence of irritable bowel syndrome and chronic fatigue resulted in loss of function, as measured by sick leave during the years following the outbreak. This will increase our knowledge about the consequences after the giardiasis outbreak, both to individual patients and to society. We expect to publish the first results in 2019.

Før utbruddet i 2004 visste vi lite om Giardia-infeksjon og konsekvensene for folks helse på lang sikt. Vi vet nå at pasientene har markant økt risiko for å få irritabel tarm syndrom og vedvarende utmattelse opptil 10 år etter den akutte infeksjonen, og at dette fører til redusert livskvalitet. I tillegg vil mange ha andre funksjonelle mage-tarmsykdommer, påvirket blærefunksjon og økt søvnbehov. Resultatene av analysene der data samlet inn fra pasientene er koblet med sykemeldingsdatabasen er ikke publisert, men arbeidet fortsetter og planen er at dette vil sluttføres etter prosjektperioden. Dette er et personlig postdoktorprosjekt for PhD Knut-Arne Wensaas som har deltatt aktivt i flere prosesser av betydning for norsk allmennmedisinsk forskning. Han har vært sentral i arbeidet med å etablere forskningsnettverk i allmennmedisin som er et nasjonalt infrastrukturprosjekt finansiert av NFR, og han har etablert samarbeid med fremragende allmennmedisinske forskningsmiljøer i England.

This project constitutes a unique possibility to investigate associations and possible mechanisms relevant to irritable bowel syndrome and chronic fatigue, conditions that are prevalent in the population and cause a substantial burden on individuals and s ociety. After an outbreak of Giardia-infection in 2004 we have followed a large cohort of patients and controls in a controlled clinical study based on this natural experiment where a planned experimental exposure is no alternative for ethical and practi cal reasons. The study group consists of 772 Giardia-patients and 904 controls that responded to a questionnaire three years after the outbreak and gave consent to linking the answers given with data from other registries. We have data on irritable bowel syndrome and chronic fatigue in this cohort, and have obtained data from the official national registry on disability pensions, rehabilitation benefits and sickness absence from January 2000 up to the latest update of the database. The knowledge on many aspects of irritable bowel syndrome, chronic fatigue and other medically unexplained conditions are limited. By linking the novel and highly significant results from our previous study three years after the Giardia-outbreak with data from the extensive n ational registries in Norway this project will provide substantial additions to the field. The project will enhance the knowledge base for preventive measures, diagnostic methods, and treatment and rehabilitation measures through a clinical trial, in acc ordance with the primary objective of the Programme on Clinical Research. The project group is based heavily in general practice, both clinically and scientifically, and the theme of the project relates primarily to general practice. Thus, the project als o answers to the programme's secondary objective to facilitate and strengthen clinical research in general practice.

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BEHANDLING-God og treffsikker diagnostikk, behandling og rehabilitering