Antibiotics Linked to Higher IBD Risk in Older Adults

Seniors prescribed multiple courses of antibiotics were at greater risk for IBD.

The use of antibiotics, regardless of class,was associated with an increased risk of older-onset Inflammatory bowel disease (IBD), according to new research presented at Digestive Disease Week (DDW) 2022, held May 21 to 24 in San Diego, California, and virtually.

Adam S. Faye, MD, MS, lead researcher on the study and assistant professor of medicine and population health at NYU Grossman School of Medicine presented the abstract,1 reviewing 2.3 million patient records that are part of Denmark’s national database, according to a DDW news release.2 

Faye and colleagues reviewed prescribing records for people aged 60 and older who were newly diagnosed with IBD from 2000 to 2018, evaluating the number of courses of antibiotics prescribed, how recently they had been prescribed in relation to the diagnosis, and specific classes of antibiotics used. 

Researchersfound that the more antibiotics prescribed to patients 60 and older, the more likely they were to develop IBD, suggesting antibiotic use could explain some of the growth in Crohn’s disease and ulcerative colitis in older people.

“In older adults, we think that environmental factors are more important than genetics,” Faye said. “When you look at younger patients with new diagnoses of Crohn disease and ulcerative colitis, there’s generally a strong family history. But that is not the case in older adults, so it’s really something in the environment that is triggering it.”

The study found any antibiotic use was associated with higher rates of IBD, and the risk went up substantially with each course. After 1 prescription, patients were 27% more likely than those with no antibiotic use to be diagnosed with IBD. With 2 courses, the risk rose by 55% and with 3 courses it skyrocketed by 67%.

With 4 courses, the risk soared by a significant 96% and with 5 or more, seniors were 236% more likely to receive a new IBD diagnosis than those with no antibiotics prescribed in the previous 5 years.

New diagnoses were highest when antibiotics were prescribed 1 to 2 years prior, but the risk remained elevated for prescriptions in the period 2 to 5 years before diagnosis.

The relationship was identifiedfor all types of antibiotics, except nitrofurantoin, which is commonly prescribed for urinary tract infections. Antibiotics usually prescribed for gastrointestinal infections were the most likely to be associated with a new IBD diagnosis.

The study has implications for diagnosing older adults with new gastroenterological symptoms, the researchers said; IBD, which can easily be overlooked in this age group, should be considered, especially when there’s a history of antibiotic prescriptions, Faye noted.

Judicious antibiotic use is crucial to preventing IBD, according to Faye.

“Antibiotic stewardship is important; but avoiding antibiotics at all costs is not the right answer either,” Faye said. “If you’re not sure what you are treating, I would be cautious. If patients are coming in with clear infections, and they need antibiotics, they should not be withheld because of these findings.”

References

1. Faye A. Antibiotics as a risk factor for older-onset ibd: population-based cohort study.Presented at: Digestive Disease Week 2022; May 21-24, 2022; San Diego, CA> Abstract 400. 

2. Antibiotic use associated with inflammatory boweldisease in olderadults. News release. Digestive Disease Week 2022. May 18, 2022. Accessed May 20, 2022. https://ddw.org/2022/05/18/antibiotic-use-associated-with-inflammatory-bowel-disease-in-older-adults/