Antibiotics Linked to Higher Risk of Inflammatory Bowel Disease

Higher cumulative exposure to systemic antibiotic therapy may be associated with a greater risk of new-onset inflammatory bowel disease (IBD) along with ulcerative colitis (UC) and Crohn disease, according to a recent study.¹

Researchers at Karolinska Institutet in Sweden and Harvard Medical School in Boston, Massachusetts, conducted the largest study thus far linking antibiotic therapy and the risk of IBD, according to the article published in the journal The Lancet Gastroenterology & Hepatology.¹

The researchers identified nearly 24,000 new patients with IBD, nearly 16,000 with UC, around 8000 with Crohn disease, and 133 with unclassified IBD. The Swedish patents 16 years and older were diagnosed between January 1, 2007, and December 31, 2016.

They also identified around 117,800 matched controls and around 28,700 siblings of the patients. They did not identify which antibiotics were prescribed.

The patients’ use of antibiotics was associated with a nearly 2-fold increased risk of IBD, after adjusting for several risk factors. Increased risk was noted for both UC and Crohn disease with the highest estimates corresponding to broad-spectrum antibiotics.

They found similar results, but slightly reduced, when siblings were used as the reference group — particularly with patients who had received 3 or more dispensations of antibiotics.

"I think this affirms what many of us have suspected: that antibiotics, which adversely affect gut microbial communities, are a risk factor for IBD," said lead author Long Nguyen, MD, with Massachusetts General Hospital and Harvard Medical School, in a press release.² ”However, despite this compelling rationale and seemingly intuitive presumption, there have been no population-scale investigations to support this hypothesis until now."

If the researchers’ findings are substantiated by longer-term prospective studies in humans or preclinical investigations, there is the need to “further emphasize antibiotic stewardship to prevent the rise in dysbiosis-related chronic diseases, including IBD,” the researchers wrote in the study.

The study was funded by the National Institutes of Health, the Crohn's and Colitis Foundation, the American Gastroenterological Association, the Massachusetts General Hospital, and Karolinska Institutet.

References:

1. Long, N., Örtqvist A Cao Y, et al. Antibiotic use and the development of inflammatory bowel disease: a national case-control study in Sweden. The Lancet Gastroenterology & Hepatology. August 27, 2020. DOI: 10.1016/S2468-1253(20)30267-3​

2. Antibiotics associated with increased risk of inflammatory bowel disease. News release. Karolinska Institutet; August 18, 2020. Accessed September 11, 2020. https://news.ki.se/antibiotics-associated-with-increased-risk-of-inflammatory-bowel-disease