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Antibiotic risk of inflammatory bowel disease

Tuesday August 18th 2020

Taking antibiotics, especially those with greater spectrum of microbial coverage, could increase the risk of new-onset inflammatory bowel disease (IBD), ulcerative colitis and Crohn’s disease, a new study claims today (18 August 2020).

In the largest study so far to link antibiotic therapy and risk of IBD and the research teams from the Karolinska Institutet in Sweden and Harvard Medical School, USA demonstrated that more frequent use of antibiotics was associated with the development of IBD and its subtypes.

Writing in The Lancet Gastroenterology & Hepatology, they say the association between antimicrobial treatment and IBD remained when patients were compared with their siblings.

Lead author Dr Long Nguyen at Massachusetts General Hospital and Harvard Medical School said: “I think this affirms what many of us have suspected—that antibiotics, which adversely affect gut microbial communities, are a risk factor for IBD.

“However, despite this compelling rationale and seemingly intuitive presumption, there have been no population-scale investigations to support this hypothesis until now.”

The researchers used the Epidemiology Strengthened by histoPathology Reports in Sweden (ESPRESSO) study to identify almost 24,000 new IBD cases - of whom 16,000 had ulcerative colitis and 8,000 Crohn’s disease – and compared them with 28,000 siblings and 117,000 controls from the general population.

Prior use of antibiotics was associated with a nearly two times increased risk of IBD after adjusting for several risk factors, while increased risk was noted for both ulcerative colitis and Crohn’s disease, with the highest estimates corresponding to broad-spectrum antibiotics.

This new study differs from previous studies because it was larger and all eligible patients with new-onset IBD from a population-based register were followed over a ten-year period, limiting selection bias.

Senior author Professor Jonas F Ludvigsson, paediatrician at Örebro University Hospital, and professor at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, said: “To identify risk factors for IBD is important, and ultimately our aim is to prevent the disease. Our study provides another piece of the puzzle and even more reason to avoid using antibiotics needlessly.”

Nguyen LH, Örtqvist AK, Cao Y et al. Antibiotic use and the development of inflammatory bowel disease: a national case-control study in Sweden. The Lancet Gastroenterology & Hepatology 17 August 2020; doi: 10.1016/ S2468-1253(20)30267-3

http://www.thelancet.com/journals/langas/article/PIIS2468-1253(20)30267-3/fulltext

Tags: Europe | Gastroenterology | North America | Pharmaceuticals

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