Doctor Adam Faye together with his study group of the NYU Grossman School of Medicine, in New York Cityhas shown that intensive use of antibiotics may be the cause of the development of Chron’s disease and other inflammatory bowel diseases (IBD) in elderly subjects.
The results of the study will be presented on Sunday 22 May at the Digestive Disease Week meeting in San Diego.
Crohn’s disease linked to intensive use of antibiotics: this is what research says
If intensive use of antibiotics is not recommended regardless of the pathology you are facing, Research developed by researchers at NYU Grossman School of Medicine in New York City has highlighted how excessive administration can lead to the development of Chron’s disease and other inflammatory bowel diseases such as ulcerative colitis.
“In older adults, we think environmental factors are more important than geneticsSaid the lead researcher, Dr. Adam Fayeassistant professor of medicine and population health at the NYU Grossman School of Medicine, in New York City.
“When looking at younger patients with newly diagnosed Crohn’s disease and ulcerative colitis, there is generally a strong family history. But that’s not the case in the elderly, so it’s really something in the environment that’s triggering it“Said Faye. For the study, Faye and her colleagues carefully studied the prescribing records for 2.3 million adults aged 60 and over in Denmark who were diagnosed with new IBD from 2000 to 2018.
The researchers found a link between any intensive antibiotic use and higher rates of IBD, and the risk increased significantly with each course of antibiotics.
Compared with those without antibiotic use in the previous five years, cyclical intensive antibiotic use was associated with a 27% higher risk of a new IBD diagnosis, two courses with a 55% higher risk, and three courses with a higher risk. greater than 67%. Four courses were related to a 96% higher risk and five or more courses with a 236% higher risk, the researchers reported.
According to the research, individuals who had taken antibiotics in the past one to two years had the highest rates of newly diagnosed IBD, but the risk remained high for those who took the drugs in the previous two to five years.
The increased risk of IBD has been found for all types of antibiotics except nitrofuroantoin, which is commonly prescribed for urinary tract infections. Antibiotics typically prescribed for gastrointestinal infections were those most likely to be associated with a new IBD diagnosis. The findings highlighted that doctors should consider IBD when they see older adults with new gastrointestinal symptoms, especially if they have a history of intensive antibiotic use.
The study also highlights the need for prudent use of antibiotics to prevent IBD and resistance to antibiotics themselves: “Antibiotic management is important, but avoiding antibiotics at all costs is also not the right answer“Said Faye. “If you are not sure what you are dealing with, I would be cautious. If patients present with obvious infections and need antibiotics, they should not be avoided because of these findings. “
As already specified, the intensive use of antibiotics is not the only cause that can lead to the development of Crohn’s disease. Ambrogio OrlandoIG-IBD Education Committee and Head of UOSD MICI AO Ospedali Riuniti Villa Sofia Cervello in Palermo, stated with respect to the increase in cases in Italy: “Numerous studies are underway, also in our country, to understand what are the risk factors of these diseases, as well as an individual’s genetic predisposition. Initially, it was hypothesized that this increase in cases was linked to a refinement of diagnostic techniques and a greater attention of clinicians to these pathologies. subsequently this hypothesis was deniedascertaining a real increase in the incidence figure “.
” The precise reasons are not known: only hypotheses are made, such as that ofintensive use of antibiotics which, in predisposed subjects, could have determined alterations of the intestinal microbiota, causing some bacteria to prevail that would have determined a change in the antigenic pattern of the intestinal mucosa on which the organism then established antibodies that constituted the first moment of pathogenetic mechanism underlying the lesions that cause these diseases “.
Paolo LionettiFull Professor of Pediatrics and Head of the Gastroenterology and Nutrition Complex Structure of the Meyer Pediatric Hospital, Florence, added: “The increase in the prevalence and incidence of IBD in the pediatric population is evident. 20-25% of cases begin in childhood or adolescence. In particular, in Italy, the data from the register of the Society of Pediatric Gastroenterology have highlighted the progressive increase of these diseases, which often begin between the ages of 8 and 12, but the impression is that some cases are anticipating up to 3- 5 years”.
“This new scenario poses new problems. 30-40% of children with Crohn’s disease suffer from growth problems; moreover, the clinical picture may be dominated by extra-intestinal manifestations which can lead to a delay in diagnosis. In the case of ulcerative colitis, however, there is a higher prevalence of pancolitis, that is a pathology that affects the entire colon and rectum, not just a part. Precisely for this reason, ad hoc pediatric guidelines have been launched and constant collaboration between pediatricians and gastroenterologists is essential “.
“The causes of this increased diagnosis in childhood are not known“, Continued Prof. Lionetti:”As with all immune-mediated diseases, there is a genetic predisposition on which environmental factors intervene. Among these, there may be the typical diet of the Western world with foods that promote inflammation and modifications of the intestinal microbiota “.
the professor. Gianluca SampietroDirector of the Division of General and Hepato-Bilio-Pancreatic Surgery, ASST Rhodense, Milan stated: “Another interesting aspect is that IBDs are virtually unknown in developing countries, but when the citizens of these countriesin the course of migratory flows, they move permanently to industrialized countries, they begin to suffer from these pathologies. We are witnessing many patients from North African states (Egypt, Morocco, Tunisia) who in their respective countries have never even heard of these pathologies nor have ever felt any symptoms, but, once in Italy, after a few years, they get sick and end up in treatment. These immune-mediated pathologies are therefore increasingly typical of industrialized countries “.
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