Antibiotic use linked with an increased risk for older-onset IBD
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The use of antibiotics, particularly those targeting gastrointestinal pathogens, was associated with an increased risk for older-onset inflammatory bowel disease, according to a researcher at the Digestive Disease Week 2022 media briefing.
“This risk is higher with each subsequent antibiotic course prescribed, in the 1-2 years following antibiotic use and with antibiotics targeting gastrointestinal pathogens,” Adam S. Faye, MD, MS, assistant professor of medicine and population health at NYU Grossman School of Medicine, told Healio.
Faye and colleagues used Denmark nationwide registries to identify 2,327,796 individuals, aged 60 to 90 years, resulting in 22,670,484 person-years of follow-up, and collected information on antibiotic exposure using the Danish National Prescription Register. A total of 10,773 new cases of ulcerative colitis and 3,825 cases of Crohn’s disease were identified during follow-up.
Investigators used incidence rate ratios (IRRs) to examine antibiotic use 1 to 5 years before diagnosis and considered number and timing of courses, as well as specific classes.
According to study results, any antibiotic use correlated with an increased IRR for the development of IBD (IRR = 1.64; 95% CI, 1.58-1.71) and increased according to antibiotic course (one course of antibiotics, IRR = 1.27, 95% CI, 1.21-1.33; two courses, IRR = 1.54, 95% CI, 1.46-1.63; three courses, IRR = 1.66, 95% CI, 1.67-1.77; four courses, IRR = 1.96, 95% CI, 1.83-2.09; and five or more courses, IRR = 2.35, 95% CI, 2.24-2.47).
“When you look at the number of courses of antibiotics, you can see that there's a positive dose response,” Faye said during the presentation, noting that they performed sensitivity and subsequent analysis 10 years out and the risks persisted. “With one course you can see that patients were 27% more likely to have an IBD diagnosis compared to patients who didn't have any antibiotic courses. When you have five or more courses, the risk was 236% higher.”
In addition, Faye and colleagues noted a higher IRR 1 to 2 years prior to IBD diagnosis (IRR = 1.87; 95% CI, 1.79-1.94) compared with 2 to 5 years before diagnosis (IRR = 1.42; 95% CI, 1.36-1.48).
Researchers further observed that all antibiotic classes, including those not used to treat gastrointestinal infections, correlated with the development of IBD. Among the antibiotics with the highest IRR were fluroquinolones (IRR = 2.27; 95% CI, 2.08-2.48), nitroimidazoles (IRR = 2.21; 95% CI, 1.95-2.50) and macrolides (IRR = 1.74; 95% CI, 1.64-1.84).
“The association between antibiotic exposure and the development of older-onset IBD underscores the importance of antibiotic stewardship as a public health measure and should make us judicious in our use of antibiotics in this population,” Faye said. “When evaluating an older individual with new onset gastrointestinal symptoms and recent antibiotic exposure, we should consider IBD higher on our differential diagnosis.
“Our study lays the groundwork for future studies to assess changes in the intestinal microbiome as a result of antibiotic use, which clinically can help with prediction and prevention.”
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Faye AS et al. Abstract 400. Presented at: Digestive Disease Week; May 21-24, 2022; San Diego (hybrid meeting).
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