Exaggerating with antibiotics favors the onset of ulcerative colitis and Crohn's disease

Exaggerating with antibiotics is a risk not only because the more they are used, the more likely resistant germs appear which can become difficult to eradicate: data presented during the latest Digestive Disease Week of the American Gastroenterological Association demonstrate that theexcess antibiotics increases the risk of developing chronic inflammatory bowel diseaseas Crohn's disease or Ulcerative colitis. The results come from a large Danish survey for which new diagnoses of chronic intestinal inflammatory diseases (or IBD) in people over sixty were analyzed.

I study

Even if in absolute terms the risk remains low, the analysis shows that with a course of antibiotics followed in the last five years the probability of diagnosis increases by 27 percentwith two cycles it rises to 55 percent and so on, up to one increase of 236 percent if more than five prescriptions have been received in the last five years, regardless of the class of antibiotics used and with a clear effect especially with medicines to treat intestinal infections. A verdict which, in addition to confirming how careful it is to be cautious with antibiotics, confirms what experts have long suspected, namely that genetic predisposition, but also the environment, matters for the development of IBD.

Doubling of cases

The indiscriminate use of antibiotics is a key element: it is also seen that they are subjected to many cycles during childhood the risk increasesprobably because protective intestinal flora strains are “lost”, useful for making the immune system stronger and therefore reducing the risk of autoimmune and inflammatory diseases, he confirms Silvio Danese, professor of Gastroenterology at the Vita-Salute San Raffaele University and head of Gastroenterology and digestive endoscopy at the Irccs San Raffaele Hospital in Milan. Diet is also decisive, although we don't know the “recipe” for prevention and there are currently no prohibited foods, but only common sense indications. According to expert projections, Crohn's and ulcerative colitis are on the increase and cases are estimated to double by 2030, when Italian patients will be around 500 thousand; the diagnosis is still not always rapid because, especially in the case of Crohn's disease, the symptoms are often confused with those of
irritable colon
, especially if in addition to poorly formed stools and gastrointestinal symptoms there are no manifestations such as joint pain, weight loss, perianal fistulas; ulcerative colitis, on the other hand, is usually recognized more quickly, because the diarrhea with blood loss is very frequent and distinctive.

The therapies

Today there are many treatment options and for patients with moderate to severe ulcerative colitis for example on the way upadacitiniba biological drug to be taken orally that selectively inhibits enzymes involved in the inflammatory cascade of the disease: already used in pathologies such asto

rrheumatoid tritis and psoriatic, has recently received a positive opinion from the Committee for Medicinal Products for Human Use of the European Medicines Agency, on the basis of a large study coordinated by Danese and published in The Lancet in which the effects in phase initial treatment, when necessary to extinguish the inflammation, and as maintenance in the medium-long term. We observed that upadacitinib provided clinical benefits just one day after starting the treatment, a very significant advantage, explains Danese.
I'm there for good news also for patients with Crohn's disease: at the same time we published positive data on risankizumab, a biologic that is taken subcutaneously and blocks IL-23, a pro-inflammatory cytokine involved in Crohn's disease. Already used for example against psoriasis, it promotes the healing of the intestinal mucosa and works well both in those who have never been treated with biologics and in those who have already followed various lines of therapy. It is conceivable that both will arrive in the clinic shortly, but already today biologics are mostly prescribed for the treatment. Now you can also choose biobetters, biosimilars with a modified formulation so that they can be taken subcutaneously rather than intravenously like infliximab, the monoclonal antibody from which they derive: in addition to allowing economic savings, they improve the distribution of the drug in the body, favoring a duration of 'major action, concludes Danese.

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