Review | Published:

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

The American Journal of Gastroenterology volume 109, pages 17281738 (2014) | Download Citation

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.

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Author information

Affiliations

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

    • Ryan Ungaro
    • , Jean-Frédéric Colombel
    •  & Ashish Atreja
  2. University of Manitoba, Winnipeg, Manitoba, Canada

    • Charles N Bernstein
    •  & Souradet Shaw
  3. University of Otago, Christchurch, New Zealand

    • Richard Gearry
  4. Statens Serum Institut, Copenhagen, Denmark

    • Anders Hviid
  5. Children’s Hospital, University of Helsinki, Helsinki, Finland

    • Kaija-Leena Kolho
  6. Seattle Children’s Hospital, Seattle, Washington, USA

    • Matthew P Kronman
  7. University of Connecticut, Storrs, Connecticut, USA

    • Herbert Van Kruiningen

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Competing interests

Guarantor of the article: Ashish Atreja, MD, MPH.

Specific author contributions: R.U.: study design, data collection, data analysis and interpretation, and writing and editing the paper; C.N.B., A.H., K.-L.K., M.P.K., S.S., and H.V.K.: provided extra data and reviewed the paper; J.-F.C.: study design, data interpretation, and writing and editing the paper; A.A.: study design, data collection, data analysis and interpretation, and writing and editing the paper.

Financial support: None.

Potential competing interests: None.

Corresponding author

Correspondence to Ashish Atreja.

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DOI

https://doi.org/10.1038/ajg.2014.246

SUPPLEMENTARY MATERIAL is linked to the online version of the paper at http://www.nature.com/ajg

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