October 2, 2022

Early antibiotics linked to increased risk of abdominal pain

New research shows that using antibiotics in the first week of life leads to a risk of developing abdominal pain 4 to 6 years later.

A team, led by Kim Kamphorst, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, dept. Pediatrics, Amsterdam Gastroenterology, Metabolism & Nutrition, Amsterdam Reproduction & Development Amsterdam, determined whether antibiotics in the first week of life, infantile colic in the first year of life, gut-associated immune markers at 1 year and allergies at 4-6 years of age in term infants is linked to a higher prevalence of functional gastrointestinal disorders at 4-6 years.

The connection

The use of antibiotics could lead to the development of various functional gastrointestinal disorders.

In the prospective observational cohort, researchers looked at 436 full-term infants up to 4 to 6 years of age. Of this group, 151 received broad-spectrum antibiotics and 285 were healthy controls.

In addition, the parents of 81% (n = 340) of the available children submitted the ROME III and ISAAC questionnaires.

Investigators used independent t-tests, chi-square tests or nonparametric tests, and multivariate logistic regression analyses.

Functional abdominal pain and antibiotics

The presence of functional abdominal pain was significantly higher in the antibiotic cohort than in the control group (4% versus 0.4% respectively; P = 0.045) and children with food allergy met criteria for irritable bowel syndrome (IBS) and abdominal migraine significantly more often (26% versus 9%; P = 0.002 and 7% versus 1%; P = 0.043 respectively) compared to pediatric patients without allergies.

However, there were no differences in functional gastrointestinal disorders at age 4 to 6 years between participants with or without a history of infantile colic, but there were significant differences in immune markers associated with the bowel between pediatric patients with and without functional gastrointestinal disorders.

“Antibiotics in the first week of life resulted in a higher risk of functional abdominal pain at 4-6 years,” the authors wrote. “Furthermore, food allergy was associated with IBS and abdominal migraine between ages 4 and 6.”

A multidisciplinary approach to care

In the past, researchers have sought to implement a multi-care approach to treating functional gastrointestinal disorders, as only a small percentage of patients with functional gastrointestinal disorders typically experience improvement in symptoms after receiving treatment by a gastroenterologist. Although proven, psychological, behavioral and dietary therapies are not usually provided.

In an open-label, single-centre, pragmatic trial, researchers based in Australia examined 144 patients aged 18 to 80 with a functional gastrointestinal disorder defined by the Rome IV criteria.

Patients were randomly assigned to receive either gastroenterologist-only standard care (n=46) or multidisciplinary clinical care (n=98) including gastroenterologists, dietitians, gut-focused hypnotherapists, psychiatrists and behavioral physiotherapists.

A total of 26 patients in the standard care group and 82 in the multidisciplinary care group saw an overall improvement in symptoms (RR, 1.50; 95% CI, 1.13-1.93; P = 0.00045) 29 patients in the standard care group and 81 patients in the multidisciplinary care group had adequate symptom relief over the past 7 days (P = 0.010).

Additionally, patients in the multidisciplinary care group were more likely to experience a 50% or greater reduction in all symptom clusters in the gastrointestinal symptom severity index than patients in the standard care group.

There was a reduction of 50 or more points for patients with irritable bowel syndrome in the IBS-SSS in 10 of 26 standard care patients and 13 of 28 patients in the multidisciplinary care group (P = 0.017).

The study, “Neonatal antibiotics and food allergies are associated with FGID between 4 and 6 years of agewas published online in Gastroenterology.