Abstract
BackgroundThe intestinal microbiota has been proposed to play a pathogenic role in coeliac disease (CD). Although antibiotics are common environmental factors with a profound impact on intestinal microbiota, data on antibiotic use as a risk factor for subsequent CD development are scarce.MethodsIn this population-based case–control study we linked nationwide histopathology data on 2,933 individuals with CD (Marsh stage 3; villous atrophy) to the Swedish Prescribed Drug Register to examine the association between use of systemic antibiotics and subsequent CD. We also examined the association between antibiotic use in 2,118 individuals with inflammation (Marsh 1–2) and in 620 individuals with normal mucosa (Marsh 0) but positive CD serology. All individuals undergoing biopsy were matched for age and sex with 28,262 controls from the population.ResultsAntibiotic use was associated with CD (Odds ratio [OR] = 1.40; 95% confidence interval [CI] = 1.27-1.53), inflammation (OR = 1.90; 95% CI = 1.72–2.10) and normal mucosa with positive CD serology (OR = 1.58; 95% CI = 1.30–1.92). ORs for prior antibiotic use in CD were similar when we excluded antibiotic use in the last year (OR = 1.30; 95% CI = 1.08-1.56) or restricted to individuals without comorbidity (OR = 1.30; 95% CI = 1.16 – 1.46).ConclusionsThe positive association between antibiotic use and subsequent CD but also with lesions that may represent early CD suggests that intestinal dysbiosis may play a role in the pathogenesis of CD. However, non-causal explanations for this positive association cannot be excluded.
Highlights
The intestinal microbiota has been proposed to play a pathogenic role in coeliac disease (CD)
Cigarette smoking has been more strongly associated with colorectal adenomas compared with colorectal cancer [12,13]. In this case–control study we linked nationwide histopathology data on individuals undergoing small intestinal biopsy to the Swedish Prescribed Drug Register in order to examine the association between use of antibiotics and CD
About 40% of those with CD were diagnosed in childhood and the majority of study participants were female (Table 1)
Summary
The intestinal microbiota has been proposed to play a pathogenic role in coeliac disease (CD). Antibiotics are common environmental factors with a profound impact on intestinal microbiota, data on antibiotic use as a risk factor for subsequent CD development are scarce. Half of all children in many Western countries receive antibiotics at least once a year [6]. Antibiotics can have both short- and long-term effects on the ecological balance between the host and the normal microbiota [7,8]. Despite the profound impact of antibiotics on the gut microbiome, there are few data on antibiotic exposure and risk of CD
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