O-004 YI Antibiotics and Risk of New Onset Inflammatory Bowel Disease

Abstract

Previous studies have suggested that antibiotics may be associated with new onset inflammatory bowel disease (IBD). The aim of this study was to evaluate antibiotic exposure as a risk factor for developing IBD. A literature search using Medline, Cochrane, and Embase databases as well as major conference abstracts from the last 2 years was performed to identify comparative 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 exposures prior to diagnosis of IBD. Data on CD, UC, and IBD incidence and antibiotic exposure were extracted from each study. A random-effect meta-analysis was conducted to determine overall pooled estimates and 95% confidence intervals (CI) for the incidence of IBD in patients exposed to antibiotics and those not exposed. A total of 12 observational studies (9 case-control and 3 cohort) that included 8,297 patients diagnosed with IBD were analyzed. The pooled odds ratio (OR) for IBD among patients exposed to any antibiotic was 1.62 (95% CI 1.31–2.01). Antibiotic exposure was significantly associated with CD (OR = 1.85, 95% CI 1.42–2.40) but was not significant for UC (OR = 1.08, 95% CI 0.91–1.27). When combining data from studies that reported on specific classes of antibiotics, all antibiotics appeared to be associated with IBD with the exception of penicillin (OR = 1.12, 95% CI 0.76–1.64). Exposure to metronidazole (OR = 5.01, 95% CI 1.65–15.25) or quinolones (OR = 1.79, 95% CI 1.03–3.12) was most strongly associated with new onset IBD. Exposure to antibiotics appears to increase the odds of being newly diagnosed with IBD. Most antibiotic classes are associated with IBD. Antibiotic use is associated with new onset CD but not new onset UC.