Antibiotics Associated With Increased Risk of New-Onset... : Official journal of the American College of Gastroenterology | ACG (original) (raw)

Review

Antibiotics Associated With Increased Risk of New-Onset Crohn’s Disease But Not Ulcerative Colitis: A Meta-Analysis

Ungaro, Ryan MD1; Bernstein, Charles N MD2; Gearry, Richard MB ChB, PhD3; Hviid, Anders MSc4; Kolho, Kaija-Leena MD, PhD5; Kronman, Matthew P MD, MSCE6; Shaw, Souradet MSc2; Van Kruiningen, Herbert MD7; Colombel, Jean-Frédéric MD, PhD1; Atreja, Ashish MD, MPH1

1 Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA

2 University of Manitoba, Winnipeg, Manitoba, Canada

3 University of Otago, Christchurch, New Zealand

4 Statens Serum Institut, Copenhagen, Denmark

5 Children’s Hospital, University of Helsinki, Helsinki, Finland

6 Seattle Children’s Hospital, Seattle, Washington, USA

7 University of Connecticut, Storrs, Connecticut, USA

Correspondence: Ashish Atreja, MD, MPH, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, New York 10029, USA. E-mail: [email protected]

SUPPLEMENTARY MATERIAL accompanies this paper at https://links.lww.com/AJG/B25, https://links.lww.com/AJG/B26

Received 2 April 2014; accepted 1 July 2014

published online 16 September 2014

Abstract

OBJECTIVES:

The objective of this study was to perform a meta-analysis investigating antibiotic exposure as a risk factor for developing inflammatory bowel disease (IBD).

METHODS:

A literature search using Medline, Embase, and Cochrane databases was performed to identify studies providing data on the association between antibiotic use and newly diagnosed IBD. Included studies reported Crohn’s disease (CD), ulcerative colitis (UC), or a composite of both (IBD) as the primary outcome and evaluated antibiotic exposure before being diagnosed with IBD. A random-effects meta-analysis was conducted to determine overall pooled estimates and 95% confidence intervals (CIs).

RESULTS:

A total of 11 observational studies (8 case–control and 3 cohort) including 7,208 patients diagnosed with IBD were analyzed. The pooled odds ratio (OR) for IBD among patients exposed to any antibiotic was 1.57 (95% CI 1.27–1.94). Antibiotic exposure was significantly associated with CD (OR 1.74, 95% CI 1.35–2.23) but was not significant for UC (OR 1.08, 95% CI 0.91–1.27). Exposure to antibiotics most markedly increased the risk of CD in children (OR 2.75, 95% CI 1.72–4.38). All antibiotics were associated with IBD, with the exception of penicillin. Exposure to metronidazole (OR 5.01, 95% CI 1.65–15.25) or fluoroquinolones (OR 1.79, 95% CI 1.03–3.12) was most strongly associated with new-onset IBD.

CONCLUSIONS:

Exposure to antibiotics appears to increase the odds of being newly diagnosed with CD but not UC. This risk is most marked in children diagnosed with CD.