Antibiotic use, regardless of class, has been linked to an increased risk of older-onset inflammatory bowel disease (IBD), according to new research presented at Digestive Disease Week (DDW) 2022, held May 21-24 in San Diego, Calif., and virtually.
Adam S. Faye, MD, MS, principal investigator of the study and assistant professor of medicine and population health at NYU Grossman School of Medicine presented the abstract,1 reviewing 2.3 million patient records that are part of Denmark’s national database, according to a DDW press release.2
Faye and colleagues reviewed the prescription records of people aged 60 and older newly diagnosed with IBD from 2000 to 2018, assessing the number of courses of antibiotics prescribed, when they were prescribed versus diagnosis, and classes specific to the antibiotics used. .
The researchers found that the more antibiotics patients aged 60 and over prescribed, the more likely they were to develop IBD, suggesting that antibiotic use may explain some of the growth in Crohn’s disease and ulcerative colitis in the elderly.
“In older people, we think environmental factors are more important than genetics,” Faye said. “When you look at younger patients with new diagnoses of Crohn’s disease and ulcerative colitis, there’s usually a strong family history. But that’s not the case in older people, so it’s really something in the environment that triggers it.
The study found that any use of antibiotics was associated with higher rates of IBD and the risk increased significantly with each treatment. After 1 prescription, patients were 27% more likely than those who did not use antibiotics to be diagnosed with IBD. With 2 courses the risk increased by 55% and with 3 courses it skyrocketed by 67%.
With 4 courses, risk jumped 96% and with 5 or more courses, seniors were 236% more likely to be newly diagnosed with IBD than those who had not been prescribed antibiotics in the previous 5 years .
New diagnoses were highest when antibiotics were prescribed 1-2 years prior, but the risk remained high for prescriptions in the 2-5 year period prior to diagnosis.
The relationship was identified for all types of antibiotics except nitrofurantoin, which is commonly prescribed for urinary tract infections. Antibiotics usually prescribed for gastrointestinal infections were the most likely to be associated with a new diagnosis of IBD.
The study has implications for the diagnosis of older people with new gastroenterological symptoms, the researchers said; IBD, which can easily be overlooked in this age group, needs to be considered, especially when there is a history of antibiotic prescriptions, Faye noted.
Judicious use of antibiotics is crucial to preventing IBD, according to Faye.
“Antibiotic management is important; but avoiding antibiotics at all costs is also not the right answer,” Faye said. “If you’re not sure what you’re dealing with, I’d be cautious. If patients arrive with clear infections and require antibiotics, they should not be turned away based on these findings.
1. Faye A. Antibiotics as a risk factor for older IBD: a population-based cohort study. Presented at: Digestive Disease Week 2022; May 21-24, 2022; San Diego, CA > Abstract 400.
2. Antibiotic use associated with inflammatory bowel disease in the elderly. Press release. Digestive Disease Week 2022. May 18, 2022. Accessed May 20, 2022. https://ddw.org/2022/05/18/antibiotic-use-associated-with-inflammatory-bowel-disease-in-older-adults/