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. 2023 Apr;72(4):663-670.
doi: 10.1136/gutjnl-2022-327845. Epub 2023 Jan 9.

Antibiotic use as a risk factor for inflammatory bowel disease across the ages: a population-based cohort study

Adam S Faye  1 , Kristine Højgaard Allin  2   3 , Aske T Iversen  2 , Manasi Agrawal  2   4 , Jeremiah Faith  5 , Jean-Frederic Colombel  4 , Tine Jess  2   3
Affiliations

Antibiotic use as a risk factor for inflammatory bowel disease across the ages: a population-based cohort study

Adam S Faye et al. Gut. 2023 Apr.

Abstract

Background: There is an increasing incidence of inflammatory bowel disease (IBD) for which environmental factors are suspected. Antibiotics have been associated with development of IBD in earlier generations, but their influence on IBD risk in adults is uncertain.

Objective: To assess the impact of antibiotic exposure, including dose-response, timing and antibiotic class, on the risk of IBD in all individuals aged ≥10 years.

Design: Using Denmark nationwide registries, a population-based cohort of residents aged ≥10 years was established between 2000 and 2018. Incidence rate ratios (IRRs) for IBD following antibiotic exposure were calculated using Poisson regression.

Results: There were a total of 6 104 245 individuals, resulting in 87 112 328 person-years of follow-up, and 52 898 new cases of IBD. Antibiotic exposure was associated with an increased risk of IBD as compared with no antibiotic exposure for all age groups, although was greatest among individuals aged 40-60 years and ≥60 years (age 10-40 years, IRR 1.28, 95% CI 1.25 to 1.32; age 40-60 years, IRR 1.48, 95% CI 1.43 to 1.54; age ≥60 years, IRR 1.47, 95% CI 1.42 to 1.53). For all age groups a positive dose-response was observed, with similar results seen for both ulcerative colitis and Crohn's disease. The highest risk of developing IBD was seen 1-2 years after antibiotic exposure, and after use of antibiotic classes often prescribed to treat gastrointestinal pathogens.

Conclusion: Antibiotic exposure is associated with an increased risk of IBD, and was highest among individuals aged 40 years and older. This risk increased with cumulative antibiotic exposure, with antibiotics targeting gastrointestinal pathogens and within 1-2 years after antibiotic exposure.

Keywords: antibiotics; inflammatory bowel disease.

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Conflict of interest statement

Competing interests: ASF: Research support from Crohn’s and Colitis Foundation; consultant for GLG, M3, Janssen, Guidepoint. JF: consultant Vedanta Biosciences and Innovation Pharmaceuticals; Scientific Advisory Board Vedanta Biosciences. JC: research grants from AbbVie, Janssen Pharmaceuticals and Takeda; payment for lectures from AbbVie, Amgen, Allergan, Inc. Ferring Pharmaceuticals, Shire and Takeda; consulting fees from AbbVie, Amgen, Arena Pharmaceuticals, Boehringer Ingelheim, BMS, Celgene Corporation, Eli Lilly, Ferring Pharmaceuticals, Galmed Research, Genentech, Glaxo Smith Kline, Janssen Pharmaceuticals, Kaleido Biosciences, Imedex, Immunic, Iterative Scopes, Merck, Microba, Novartis, PBM Capital, Pfizer, Sanofi, Takeda, TiGenix, Vifor; holds stock options in Intestinal Biotech Development.

Figures

Figure 1
Figure 1
Incidence rate ratios (IRRs) for the development of inflammatory bowel disease (IBD), ulcerative colitis (UC) and Crohn’s disease (CD) based on the number of antibiotic courses.
Figure 2
Figure 2
Incidence rate ratios (IRRs) for the development of inflammatory bowel disease (IBD), ulcerative colitis (UC) and Crohn’s disease (CD) based on antibiotic class.
See this image and copyright information in PMC

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