Antibiotics can Increase the Risk of Crohn’s Disease

Antibiotic use is linked to an increased risk of irritable bowel syndrome.

Highlights:

Frequent use of antibiotics may heighten inflammatory bowel disease risk in adults over 40 years
Drugs such as nitroimidazoles and fluoroquinolones have been linked to an increase in the number of cases of irritable bowel syndrome
Apart from antibiotics, the gut microbiome and other environmental factors are also responsible for irritable bowel syndrome

Regular use of Antibiotics may increase the risk of inflammatory bowel illness (Crohn's disease and ulcerative colitis) in people over 40 years, according to a study published online in the journal Gut.

The risk appears to be cumulative and is greatest 1-2 years after the use of antibiotics used to treat gastrointestinal infections, according to the findings.

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‘People who used antibiotics frequently and were aged between 10–40 years were 28% more likely to be diagnosed with IBD, those aged between 40–60 years were 48% more probable, and those over 60 years were 47% more probable.’

Environmental variables are likely involved in the development of inflammatory bowel disease (IBD), according to mounting research. According to the researchers, close to 7 million people worldwide have the illness, with that figure predicted to climb over the next decade ().

Antibiotic use is one factor associated with IBD risk in younger people, but it is unclear whether this association holds in older people.

To dig deeper, the researchers examined national medical data from 2000 to 2018 for Danish citizens aged 10 and above who had not been diagnosed with IBD. They were particularly interested in learning whether the time and dose of antibiotics were relevant in the development of IBD and whether this varied by IBD and antibiotic type ().

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The survey comprised approximately 6.1 million people, with women accounting for slightly more than half of the participants. Between 2000 and 2018, 5.5 million people (91%) were prescribed at least one course of antibiotics. Approximately 36,017 new instances of ulcerative colitis and 16,881 new cases of Crohn's disease were diagnosed during this period.

Overall, usage of these medicines was associated with a greater risk of developing IBD, regardless of age, as compared to no use. However, older age was associated with the greatest risk.

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Those aged between 10–40 years were 28% more likely to be diagnosed with IBD, those aged between 40–60 years were 48% more probable, and those over 60 years were 47% more likely.

Crohn's disease had a somewhat greater risk than ulcerative colitis: 40% among 10- to 40-year-olds, 62% among 40- to 60-year-olds, and 51% among those over 60. The danger appeared to be cumulative, with each consecutive course increasing the risk by 11%, 15%, and 14%, respectively, depending on the age band.

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The biggest risk was reported among individuals prescribed five or more courses of antibiotics: a 69% increase in risk for 10- to 40-year-olds, a doubling in risk for 40- to 60-year-olds, and a 95% increase in risk for those over 60.

The timing appeared to be important as well, with the largest risk for IBD occurring 1-2 years following antibiotic exposure and each subsequent year associated with a decrease in risk.

IBD risk was 40% greater 1-2 years after using antibiotics among 10- to 40-year-olds, compared to 13% 4-5 years later. The similar figures for 40- to 60-year-olds were 66% vs. 21% and 63% vs. 22% for those over 60.

In terms of antibiotic class, nitroimidazoles and fluoroquinolones, which are commonly used to treat gut infections, were associated with the highest risk of IBD. Broad-spectrum antibiotics are so named because they target all bacteria, not just those that cause disease.

Nitrofurantoin was the only antibiotic that was not linked to an increased risk of IBD at any age.

Narrow-spectrum penicillin have also been linked to IBD, albeit to a lesser degree. This lends credence to the idea that alterations in the gut microbiome may play an important role and that many medications can alter the composition of microorganisms in the gut.

Because this is an observational study, the cause cannot be determined. The researchers also remark that there is no information available on what the medications were for or how many of the patients consumed them.

However, they provide some reasonable scientific explanations for the findings, noting the natural decline in both the resilience and diversity of microorganisms in the gut microbiome associated with age, which antibiotic use is expected to exacerbate. "Furthermore, with repeated courses of antibiotics, these shifts can become more pronounced, ultimately limiting recovery of the intestinal microbiota," they add. Limiting prescriptions for antibiotics may not only help to curb antibiotic resistance but may also help lower the risk of IBD, they venture.

"The association between antibiotic exposure and the development of IBD underscores the importance of antibiotic stewardship as a public health measure, and suggests the gastrointestinal microbiome as an important factor in the development of IBD, particularly among older adults," they conclude.

Antibiotics: A Boon or Bane for Crohn's Disease Patients?

Research suggests that too much bacteria in the small intestine may be common in people with IBS. Antibiotics, which kill bacteria, may help bring the bacterial balance closer to normal.

These medicines may:

Reduce the dangers of harmful gut bacteria.
Help protect the intestinal lining from bacterial infection.
Lower inflammation is the body’s attack against bacteria and viruses.
Preserve healthy bacteria in the colon.

References:

Antibiotics, gut microbiota, and irritable bowel syndrome: What are the relations? - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8968486/)
Antibiotic use as a risk factor for inflammatory bowel disease across the ages: a population-based cohort study - (https://gut.bmj.com/content/early/2023/01/03/gutjnl-2022-327845)

Source-Medindia