Frequent antibiotic use linked to higher risks of Crohn’s disease and colitis

By Steven Reinberg Health Day Reporter

FRIDAY, Jan. 13, 2023 (HealthDay News) — Overuse of antibiotics can trigger inflammatory bowel disease (IBD), according to new research.

Among people age 40 or older, a new study has found that antibiotics may increase the risk of bowel diseases, such as Crohn’s disease and ulcerative colitis, for one to two years after their use. And the greatest risk was posed by two classes of antibiotics – nitroimidazoles and fluoroquinolones – often used to treat intestinal infections.

The researchers said these drugs indiscriminately target all bacteria, not just those that cause disease.

“Antibiotics can impact the development of IBD by altering the microbiome,” said the lead researcher Dr. Adam Faye. He is an assistant professor at the Grossman School of Medicine at New York University, New York.

To reduce your risk of IBD, Faye advises using antibiotics only when needed and not for viral illnesses such as colds, flu or other respiratory and gastrointestinal illnesses.

“We want patients to get better quickly, so we may be more inclined to prescribe an antibiotic in some of these settings, but in addition to exacerbating bacterial resistance patterns, that’s another reason to practice disease management. antibiotics,” Faye said. “In other words, use antibiotics when needed, but be careful when prescribing them for an infection that is likely to be self-limiting or more likely viral.”

Overuse of antibiotics can alter the bacterial balance in the gut, called the microbiome, with serious consequences, Faye warned.

This study, however, does not prove that antibiotics cause inflammatory bowel disease, only that there appears to be a link.

For the study, Faye’s team used a Danish national medical database from 2000 to 2018 of more than 6.1 million Danes who had not been diagnosed with IBD. In total, 91% were prescribed at least one course of antibiotics during the study period.

From 2000 to 2018, more than 36,000 people were diagnosed with ulcerative colitis and nearly 17,000 with Crohn’s disease.

Faye’s team found that among people who had taken antibiotics, those aged 10-40 were 28% more likely to be diagnosed with IBD, as were 48% of people aged 40-60 and 47% of those in their 60s or older.

The risk was slightly higher for Crohn’s disease than for ulcerative colitis: 40% among 10 to 40 year olds; 62% among 40-60 year olds; and 51% among people in their 60s or older.

The researchers noted that the risk increased with each course of antibiotics, adding 11% to the risk for the youngest group and 14% for the oldest.

Those who took five or more courses of antibiotics had the highest risk of developing IBD: for people aged 10 to 40, the risk jumped 69%. It doubled for people between 40 and 60 and was 95% higher for people in their 60s or older.

How long it had been since taking antibiotics was also a factor. It was up to 66% higher in the first two years, falling to as low as 13% after four or five years.

Dr. Bethany DeVitoassociate chief of outpatient clinical gastroenterology at Northwell Health in Great Neck, NY, noted that the gut microbiome is very complex.

“Any alteration in the microbiome can lead to diseases, especially of the gastrointestinal tract with irritable bowel syndrome,” she said after reviewing the results. “There is some discussion that this is a factor causing inflammatory bowel disease, due to the inflammation that can result from the change in the microbiome.”

Antibiotics can alter the microbiome and cause diarrhea, gas, and bloating. So, DeVito said, the connection to IBD is not surprising.

“Only use antibiotics if you have a clear indication,” she advised. “Many patients want antibiotics for all sorts of illnesses and doctors can find it hard to resist prescribing them.”

These requests can be annoying, and doctors need to hold their ground and say no, DeVito said.

“Everyone is looking for a magic pill and not realizing there are consequences to that magic,” she said.

The study was published online Jan. 9 in the journal Intestine.

SOURCES: Adam Faye, MD, assistant professor, department of population health, NYU Grossman School of Medicine, New York; Bethany DeVito, MD, associate chief, outpatient clinical gastroenterology, Northwell Health, Great Neck, NY; Intestine, January 9, 2023, online

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