Medically reviewed by Onikepe Adegbola, MD, PhD
A recently published scientific report from Japan supports a long-existing theory of the association between antibiotic use and the incidence of inflammatory bowel disease (IBD). The report titled “The risk of antibiotics and enterocolitis for the development of inflammatory bowel disease: a Japanese administrative database analysis” was published in Scientific Reports – Nature.
Several population-based studies have already found a probable link between excessive antibiotic use and the likelihood of developing inflammatory bowel disease in people. There was also speculation about a link between enterocolitis (intestinal inflammation) and inflammatory bowel disease. This study looked at the link between antibiotic use and enterocolitis and the development of inflammatory bowel disease in both children and adults.
A previously published report from a Canadian report about the association of inflammatory bowel disease with antibiotics suggested that almost all antibiotics could be provocative agents for the incidence of the disease. However, through this study, the authors could conclude that not all antibiotics are associated with IBD.
Inflammatory bowel disease (IBD), which encompasses Crohn’s disease (CD) and ulcerative colitis (UC), is defined by chronic intestine inflammation produced by an abnormal intestinal immune response to luminal contents in genetically susceptible people.
How was this study conducted?
An analysis of population-based administrative data from the Japan Medical Data Centre (JMDC) health insurance claims database was included in the study. The database was used to find five matched volunteers without IBD who had just been diagnosed with CD and UC. Antibiotic use and enterocolitis events from one and two years before the diagnosis date were studied. There were 371 CD patients and 2420 UC patients in all. Patients who had never been exposed to antibiotics and were later diagnosed with either UC or CD (controls) were chosen in a ratio of 1:5, resulting in 1855 control participants with CD and 12,100 control individuals with UC.
This study could fully analyze the association between antibiotics and IBD if it included bigger population data, whether prescribed as an outpatient or provided in a hospital setting. Bacterial infections such as E. coli enterocolitis, Campylobacter enterocolitis, and Clostridium difficile enterocolitis (CDE), including pseudomembranous enterocolitis, were also investigated as potential causes of IBD.
Which antibiotics increase the risk of IBD?
Antibiotics such as penicillin, cephalosporin, macrolide, and quinolone have been linked to an increased risk of Crohn’s disease CD. Tetracycline, trimethoprim/sulfamethoxazole (TMP/SMXs), aminoglycosides, and antifungal drugs, on the other hand, enhance the risk of ulcerative colitis.
Are all age groups equally affected by antibiotic-induced IBD?
Enterocolitis was associated with a higher risk of causing ulcerative colitis in children and adolescents aged below 18. When it comes to adults, both antibiotic use and enterocolitis were j associated with a risk of developing IBD.
What is the importance of this study?
The previously published studies on the link between IBD and antibiotic use were mostly from western populations and could not be extrapolated to Asians. The data for this study came from a Japanese health insurance claims database, which could be representative of the Asian population. Epidemiological, real-world prescription and illness burden data were recently entered into the same database.
Is there any difference in the incidence of IBD between the Asian and Western populations?
The genetic vulnerability of Western and Asian populations differs due to variances in genetic polymorphisms. As a result, there may be variations in the incidence and type of IBD. There are few published data or studies on the Asian population. As a result, the focus of this research was on the impact of environmental factors on the development of IBD in Asian populations.
Shimodaira, Y., Watanabe, K., & Iijima, K. (2022). The risk of antibiotics and enterocolitis for the development of inflammatory bowel disease: A Japanese administrative database analysis. Scientific Reports, 12(1). https://doi.org/10.1038/s41598-022-11646-2