What impact does antibiotic exposure have on the risk of inflammatory bowel disease?

In a recent study published in intestineresearchers evaluated the impact of antibiotic use on the risk of developing inflammatory bowel disease (IBD) in individuals aged 10 years and older.

Background

IBD refers to a chronic immunological condition that affects the intestine, including two main subtypes: Crohn’s disease (CD) and ulcerative colitis (UC). Studies report an increase in his IBD cases due to questionable environmental risk factors. Antibiotic use has been linked to the development of her IBD in children. However, her potential IBD risk in adults exposed to antibiotics is unknown.

About research

In the current population-based national cohort study, researchers investigated the association between antibiotic use and IBD development in individuals aged 10 years and older. Year.

Demographic data were collected from the Danish National CRS (Citizens Registration System) for individuals aged 10 years or older who had resided in Denmark for at least 5.0 years between 1 January 2000 and 31 December 2018 and had no history of IBD. ) was obtained from Medicines were obtained from the Danish National Prescription Register in conjunction with the Civil Registration System. Drugs were coded based on an anatomical therapeutic chemical system.

Data obtained included medication code and prescription date, and the antibiotic medication/prescription date was considered the date of antibiotic use. Antibiotic class dose-response associations were assessed based on the number of antibiotic courses, and antibiotics prescribed from the same class within 1 month of use were included in one antibiotic course.

All antibiotic courses contributed to an IBD risk period of 1 to 5 years after exposure. In addition, we performed a sensitivity analysis by extending the lag time from antibiotic exposure from 1 to 2 years.

The Danish National Patient Register was utilized to obtain data on hospital admissions, outpatients, and emergency department visits. IBD diagnosis was based on the ICD-8/10 (International Classification of Diseases 8th or 10th revision) code.

Classes of antibiotics include narrow-spectrum penicillins, extended-spectrum penicillins, macrolides, nitrofurantoins, tetracyclines, and sulfonamides. In addition, fluoroquinolones and nitroimidazoles were included as they are frequently prescribed for the treatment of gastrointestinal pathogen infections.

Data on socioeconomic status and urbanization (population/m²) were obtained by linking residential addresses from the civil registration system with official Danish statistics. Medication history, particularly his PPIs (proton pump inhibitors) and antifungal and antiviral medication use, was documented as the drugs may alter the intestinal flora. Poisson regression analysis was performed to determine IRR (incidence rate ratio) values.

result

The study population consisted of 6,104,245 individuals followed for 87,112,328 years. Of the participants, 5,551,441 (91%) were prescribed 1.0 course or more of antibiotics, and 52,898 new IBD cases (36,017 and 16,881 new UC and CD cases, respectively) were recorded.

Antibiotic use increased IBD risk at all ages, but the greatest risk was observed in individuals over 40 years of age, with IRR values ​​between 10 and 40 years and 1.3 between 40 and 60 years. , 1.5, and 1.5. 60 years and older, respectively. This finding held true for CD and UC, with slightly greater risk for CD and corresponding his IRR values ​​of 1.4, 1.6 and 1.5 compared to UC, respectively.

Across age, a positive dose-response relationship was observed with comparable results in Crohn’s disease and ulcerative colitis. A sensitivity analysis yielded similar results. Each subsequent course of antibiotics increased his IBD risk, with IRR values ​​of 1.1, 1.2, and 1.1 for those aged 10–40, 40–60, and ≥60, respectively, with increases in antibiotic courses. Got it. The greatest risk was observed in individuals for whom he was prescribed antibiotic courses of ≥5.0 regardless of age, with corresponding her IRR values ​​of 1.7, 2.1, and 2.0, respectively.

The greatest risk of developing IBD was observed after 1-2 years of antibiotic use, with a decreasing risk with each subsequent year. Notably, her IRR values ​​for those aged 10 to 40 years were 1.4 at 1–2 years after antibiotic exposure and 1.1 at 4–5 years after exposure. Similarly, for people aged 40 to 60, her IRR values ​​were 1.7 at 1-2 years after antibiotic use and 1.2 at 4-5 years after use. Aged 60 years and older, her IRR values ​​were 1.6 at 1-2 years after antibiotic use and 1.2 at 4-5 years after use, with similar results for Crohn’s disease and ulcerative colitis.

The greatest risk of IBD was observed after using antibiotics that specifically target bacterial pathogens in the gastrointestinal tract. Nitrofurantoin alone was not associated with the development of IBD over age. The risk was highest for nitroimidazole, with IRR values ​​of 1.3, 1.4 and 1.6 for 10-40, 40-60 and ≥60 years, respectively. His IRR values ​​for the corresponding fluoroquinolones were 1.8, 1.8, and 1.5, respectively. Similar results were obtained for Crohn’s disease and ulcerative colitis.

As we age, our gut microbial diversity declines, increasing our susceptibility to disruption, an effect enhanced by antibiotic exposure. Antibiotic use can cause long-term intestinal microbial changes, which become increasingly pronounced with repeated courses of antibiotics, resulting in decreased microbial gut recovery.

Conclusion

Overall, the study results showed that antibiotic use increased the risk of developing IBD, especially among individuals over the age of 40. It was greatest within 1–2 years of use and after exposure to antibiotics that target gastrointestinal pathogens. This finding indicates that the gastrointestinal microbiota is an important factor in her IBD development, especially in the elderly.