Irritable Bowel Syndrome Message Boards | Data links Crohn's disease and antibiotics

Data link Crohn's disease, antibiotics - But it is unclear whether antibiotic use is a disease trigger or a result of patients seeking symptom relief.

By Victoria Stagg Elliott, AMNews staff. March 1, 2004.

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Use of antibiotics is a potential risk factor for the development of Crohn's disease, according to a paper published in the February issue of the journal Gut.

Researchers at England's University of Nottingham and Cambridge University analyzed the British General Practice Research Database for information about antibiotic use of those with and without the disease. The database includes information about diagnosing and prescribing practices of 5% of the nation's physicians and is considered to be one of the world's largest computerized databases of longitudinal anonymous patient medical records from this setting.

The researchers found that those with Crohn's received twice as many prescriptions over a five-year period and were 30% more likely to have been prescribed antibiotics.

Although Crohn's disease is primarily regarded as a genetic condition, researchers have been hunting for environmental reasons why the disease has increased significantly over the past few decades. Antibiotics are just one of many environmental triggers being scrutinized, along with factors such as appendectomies, the birth control pill, and smoking.

"Finding the environmental trigger is the million dollar question," said Subra Kugaphasan, MD, a pediatric gastroenterologist at the Medical College of Wisconsin in Milwaukee.

Researchers conceded that antibiotic use may be due in part to patients hunting for relief from symptoms before receiving a definitive diagnosis.

"Our data provide some support for antibiotic exposure playing a role, but we now need other studies particularly in children and looking at antibiotic use early in life," said Dr. Richard Logan one of the authors and a professor of clinical epidemiology at the University of Nottingham.

Experts said that although the study was provocative, the numbers did not seem strong enough to draw its conclusion even if they did reach statistical significance. Experts did say that studies like this should give physicians additional pause when it comes to prescribing antibiotics.

"Here is another condition that should make all physicians circumspect with regard to the application of antibiotics unless it's truly indicated," said Marvin L. Corman, MD, vice chair of surgery at North Shore-Long Island Jewish Medical Center in New York.

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ADDITIONAL INFORMATION:

Which comes first?

Objective: To determine if antibiotic use is linked to the development of Crohn's disease.

Participants: Patients with and without Crohn's who had five years' worth of data in Britain's General Practice Research Database.

Method: Data were extracted based on smoking status, drug prescriptions, age and sex. Logistic regression was used to investigate the relationship between Crohn's and antibiotic use.

Results: Seventy-one percent of those with Crohn's had used antibiotics in the previous five years, compared to 58% of controls. Those with the disease had twice as many antibiotic prescriptions than those without.

Conclusion: There is a statistically significant association between antibiotic use and Crohn's disease, although it is unclear whether this is the cause of the disease or a result of seeking treatment for symptoms.

Source: Gut, February

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Weblink
"Antibiotic use and the development of Crohn's disease," Gut, February (gut.bmjjournals.com/cgi/content/abstract/53/2/246)

Facts about Crohn's from the National Digestive Diseases Information Clearing House (digestive.niddk.nih.gov/ddiseases/pubs/crohns)

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Copyright 2004 American Medical Association. All rights reserved.

http://www.ama-assn.org/amednews/2004/03/01/hlsc0301.htm

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