- Researchers say adults over the age of 60 who frequently use antibiotics have a higher risk of inflammatory bowel disease.
- They say the risk increased with the addition of antibiotic prescriptions over a 5-year period.
- They add, however, that older adults should still take antibiotics when necessary.
Inflammatory bowel disease (IBD) refers to several intestinal disorders resulting from chronic inflammation of the digestive tract.
Around 3 million people in the United States have been diagnosed with IBD. Diagnosis typically occurs between the ages of 15 to 35. However, some people receive a diagnosis after 60.
When diagnosed during the younger years, genetics often plays a role. But when diagnosed in the later years, environmental factors, including medications for other conditions, could be the cause.
A study presented at the Digestive Disease Week annual conference reported that taking antibiotics can increase the risk of developing IBD in people over 60.
The study hasn’t been peer-reviewed or published yet.
According to the researchers, the more antibiotics were used, the higher the risk of developing IBD in older adults. People who took antibiotics were more likely to develop IBD than those who had not taken antibiotics within the past five years, especially with drugs used to treat gastrointestinal infections.
“Antibiotics are not the cause of IBD but probably increase the risk by altering the microbiome of the intestine and by altering the immune response to antigens,” Dr. James J. Lee, a gastroenterologist with Providence St. Joseph Hospital in California, told Healthline. “The impact of antibiotics is wide-ranging and the increased risk of developing IBD in people over 60 should not be ignored.”
Researchers said the risk of developing IBD increased with the number of prescriptions for antibiotics. People who had:
- One prescription were 27 percent more likely to be diagnosed with IBD.
- Two prescriptions were 55 percent more likely.
- Three prescriptions were 67 percent more likely.
- Four prescriptions were 96 percent more likely.
- Five or more prescriptions were 236 percent more likely.
However, experts said the research doesn’t mean you should not take antibiotics when needed.
“Our results reinforce judicious use of antibiotics, not only to prevent the development of multidrug-resistant organisms but to limit the new onset of IBD among older adults,” Dr. Adam Faye, a physician at the NYU Langone Inflammatory Bowel Disease Center in New York and lead study author, told Healthline. “Thus, in cases where a mild gastrointestinal (or any) illness is being treated or is expected to self-resolve in a few days, it might be prudent to hold off on antibiotics. However, on the other hand, this should not prevent using prescriptions of antibiotics when needed.”
The researchers reviewed prescribing records of people over 60 who were first diagnosed with IBD between 2000 and 2018.
They recorded information on prescriptions for antibiotics, what antibiotics, when prescribed, and for what reason..
The scientists reported:
- New IBD diagnoses were highest among people who were prescribed antibiotics within one to two years before their diagnosis.
- The risk remained high for people treated with antibiotics within five years before their diagnosis, although not as high as in more recent courses of antibiotics.
- Antibiotics for gastrointestinal infections were more likely to be associated with IBD.
The researchers suggest that older adults who develop gastrointestinal symptoms should be assessed for IBD, especially if they have taken antibiotics within the past several years.
“I think this is an interesting study but it shows an association only, not cause and effect,” Dr. Ashkan Farhadi, FACP, a gastroenterologist at MemorialCare Orange Coast Medical Center in Fountain Valley, California, told Healthline. “The hypothesis makes sense; the data makes sense, and I am not rejecting their conclusions. I am suggesting that we move cautiously and wait for additional studies to back up the data. At this point, I would not change how I treat my patients.”
IBD refers to conditions caused by chronic inflammation of the gastrointestinal tract, such as Crohn’s disease and ulcerative colitis.
The symptoms include:
- Stomach cramps.
- Diarrhea.
- Gas and bloating.
- Loss of appetite.
- Mucus or blood in the stool.
- Upset stomach.
Researchers have not yet determined the
Some medications used to treat IBD include:
- Aminosalicylates.
- Corticosteroids.
- Immunomodulators.
- Biologics
Symptoms of IBD are caused in part by inflammation.
“Once inflammation is present, treatment needs to be focused on controlling the inflammation, which often requires medical therapy, such as topical, biologics, small molecule inhibitors, and immunomodulators,” said Faye. “However, there is ongoing research on the role of diet and stress management in maintaining remission. We think IBD is a result of genetics and environmental factors (antibiotics) and it is difficult to discern how much each factor plays. The mainstay of therapy is controlling inflammation.”
If medications do not provide relief, your doctor might suggest other treatments.
“We have various interventions (medication, surgery, diet therapy, and cognitive behavioral therapy) that treat both active symptoms as well as symptoms which may be a sequel of prior inflammation. Fortunately, we have many advanced targeted medications which can put inflammatory bowel disease in remission and eliminate both inflammation and symptoms,” Dr. Jeffrey Berinstein, the clinical Lecturer at the Institute of Health Policy and Innovation at Michigan Medicine, told Healthline.
Crohn’s disease and ulcerative colitis affect different parts of the gastrointestinal tract, so surgery is different depending on the condition.
As more is learned about IBD and medications improve, the need for surgery has decreased.