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Meta-Analysis
. 2021 Jun;8(1):e000601.
doi: 10.1136/bmjgast-2021-000601.

Antibiotic use and colorectal neoplasia: a systematic review and meta-analysis

Chino Aneke-Nash  1 , Garrett Yoon  2 , Mengmeng Du  3 , Peter Liang  2   4
Affiliations
Meta-Analysis

Antibiotic use and colorectal neoplasia: a systematic review and meta-analysis

Chino Aneke-Nash et al. BMJ Open Gastroenterol. 2021 Jun.

Abstract

Background and aims: Colorectal cancer (CRC) is the third most common cancer for women and men and the second leading cause of cancer death in the USA. There is emerging evidence that the gut microbiome plays a role in CRC development, and antibiotics are one of the most common exposures that can alter the gut microbiome. We performed a systematic review and meta-analysis to characterise the association between antibiotic use and colorectal neoplasia.

Methods: We searched PubMed, EMBASE, and Web of Science for articles that examined the association between antibiotic exposure and colorectal neoplasia (cancer or adenoma) through 15 December 2019. A total of 6031 citations were identified and 6 papers were included in the final analysis. We assessed the association between the level of antibiotic use (defined as number of courses or duration of therapy) and colorectal neoplasia using a random effects model.

Results: Six studies provided 16 estimates of the association between level of antibiotic use and colorectal neoplasia. Individuals with the highest levels of antibiotic exposure had a 10% higher risk of colorectal neoplasia than those with the lowest exposure (effect size: 1.10, 95% CI 1.01 to 1.18). We found evidence of high heterogeneity (I2=79%, p=0.0001) but not of publication bias.

Conclusions: Higher levels of antibiotic exposure is associated with an increased risk of colorectal neoplasia. Given the widespread use of antibiotics in childhood and early adulthood, additional research to further characterise this relationship is needed.

Keywords: antibiotics; colorectal cancer; meta-analysis.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow diagram of study selection.
Figure 2
Figure 2
Forest plot of the association between highest versus lowest antibiotic exposure and colorectal neoplasia. 1Estimates for exposure at age 20–39 years were used. CRC, colorectal cancer; ES, effect size; TMP-SMX, trimethoprim-sulfamethoxazole.
Figure 3
Figure 3
Funnel plot of level of antibiotic exposure and risk of colorectal neoplasia. RR, relative risk.
See this image and copyright information in PMC

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References

    1. Sung H, Ferlay J, Siegel RL, et al. . Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021. 10.3322/caac.21660. [Epub ahead of print: 04 Feb 2021]. - DOI - PubMed
    1. Siegel RL, Torre LA, Soerjomataram I, et al. . Global patterns and trends in colorectal cancer incidence in young adults. Gut 2019;68:2179–85. 10.1136/gutjnl-2019-319511 - DOI - PubMed
    1. Marchesi JR, Dutilh BE, Hall N, et al. . Towards the human colorectal cancer microbiome. PLoS One 2011;6): :e20447. 10.1371/journal.pone.0020447 - DOI - PMC - PubMed
    1. Ahn J, Sinha R, Pei Z, et al. . Human gut microbiome and risk for colorectal cancer. J Natl Cancer Inst 2013;105:1907–11. 10.1093/jnci/djt300 - DOI - PMC - PubMed
    1. Donohoe DR, Garge N, Zhang X, et al. . The microbiome and butyrate regulate energy metabolism and autophagy in the mammalian colon. Cell Metab 2011;13): :517–26. 10.1016/j.cmet.2011.02.018 - DOI - PMC - PubMed

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