December 2, 2022

Antibiotics and the risk of inflammatory bowel disease

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Experts say older people should be somewhat selective in deciding when to take antibiotics. Willie B. Thomas/Getty Images
  • Researchers say adults over 60 who frequently use antibiotics have a higher risk of inflammatory bowel disease.
  • They say the risk increased with the addition of antibiotic prescriptions over a 5-year period.
  • They add, however, that older people should still take antibiotics if needed.

Inflammatory bowel disease (IBD) refers to several bowel disorders resulting from chronic inflammation of the digestive tract.

Approximately 3 million people in the United States have been diagnosed with IBD. Diagnosis usually occurs between the ages of 15 and 35. However, some people are diagnosed after age 60.

When diagnosed during the younger years, genetics often plays a role. But when diagnosed in recent years, environmental factors, including medications for other conditions, could be the cause.

A study presented to the Digestive Diseases Week annual conference reported that taking antibiotics may increase the risk of developing IBD in people over 60.

The study has not yet been peer reviewed or published.

According to the researchers, the more antibiotics were used, the higher the risk of developing IBD in the elderly. People who took antibiotics were more likely to develop IBD than those who hadn’t taken them in the past five years, especially with drugs used to treat gastrointestinal infections.

“Antibiotics do not cause IBD but likely increase risk by altering the gut microbiome and altering the immune response to antigens,” Dr. James J. Lee, a gastroenterologist at Providence St. Joseph Hospital in California, told Healthline. “The impact of antibiotics is vast and the increased risk of developing IBD in people over 60 should not be ignored.”

The researchers said the risk of developing IBD increased with the number of antibiotic prescriptions. People who had:

  • A prescription was 27% more likely to be diagnosed with IBD.
  • Two prescriptions were 55% more likely.
  • Three prescriptions were 67% more likely.
  • Four prescriptions were 96% more likely.
  • Five or more prescriptions were 236% more likely.

However, experts said the research doesn’t mean you shouldn’t take antibiotics when needed.

“Our results support the judicious use of antibiotics, not only to prevent the development of multidrug-resistant organisms, but also to limit the occurrence of new IBD in the elderly,” Dr. Adam Faye, a physician at NYU Langone Inflammatory Bowel Disease Center in New York City and lead author of the study, told Healthline. “So in cases where mild gastrointestinal (or any other) illness is treated or expected to resolve on its own within a few days, it might be prudent not to take antibiotics. However, on the other hand, this should not preclude the use of antibiotic prescriptions when needed.

The researchers looked at the prescription records of people over the age of 60 who were first diagnosed with IBD between 2000 and 2018.

They recorded information about antibiotic prescriptions, which antibiotics, when they were prescribed and for what reason.

The scientists reported:

  • New diagnoses of IBD were highest among people who were prescribed antibiotics within one to two years of their diagnosis.
  • The risk remained high for people treated with antibiotics in the five years before their diagnosis, but not as high as in more recent courses of antibiotics.
  • Antibiotics for gastrointestinal infections were more likely to be associated with IBD.

The researchers suggest that older people who develop gastrointestinal symptoms should be evaluated for IBD, especially if they have taken antibiotics in the past few years.

“I think it’s an interesting study but it only shows an association, not cause and effect,” Dr Ashkan Farhadi, FACP, gastroenterologist and senior member of the American College of Gastroenterology, told Healthline. “The hypothesis makes sense; the data makes sense, and I don’t reject their conclusions. I suggest we proceed with caution and wait for additional studies to back up the data. At this point, I would not change the way I treat my patients.

IBD refers to conditions caused by chronic inflammation of the gastrointestinal tract, such as Crohn’s disease and ulcerative colitis.

Symptoms include:

  • Stomach cramps.
  • Diarrhea.
  • Gas and bloating.
  • Loss of appetite.
  • Mucus or blood in the stool.
  • Stomach ache.

Researchers have yet to determine the exact cause of the IBD. Yet they believe it results from a malfunctioning immune system.

Some medications used to treat IBD include:

  • Aminosalicylates.
  • Corticosteroids.
  • Immunomodulators.
  • Organic Products

Symptoms of IBD are caused in part by inflammation.

“Once inflammation is present, treatment should focus on controlling the inflammation, which often requires medical treatment, such as topicals, biologics, small molecule inhibitors and immunomodulators,” Faye said. . “However, research is ongoing on the role of diet and stress management in maintaining remission. We believe that IBD is the result of genetic and environmental (antibiotic) factors and it is difficult to discern the importance of each factor. The mainstay of therapy is the control of inflammation.

If medications don’t provide relief, your doctor may suggest other treatments.

“We have various interventions (drugs, surgery, diet therapy and cognitive behavioral therapy) that address both active symptoms as well as symptoms that may be a sequela of previous inflammation. Fortunately, we have many advanced targeted drugs that can put inflammatory bowel disease into remission and eliminate both inflammation and symptoms,” Dr. Jeffrey Berinsteinthe clinical lecturer at Michigan Medicine’s Institute of Health Policy and Innovation, told Healthline.

Crohn’s disease and ulcerative colitis affect different parts of the gastrointestinal tract, so the surgery is different depending on the condition.

As more is learned about IBD and medications improve, the need for surgery has diminished.