Antibiotics increase risk of intestinal disease, research finds

posted on 01/10/2023 06:00


(credit: PixHere/Disclosure)

Inflammatory bowel disease (IBD) affects nearly seven million individuals worldwide, and experts predict this number could rise in the coming decades. To understand the risk factors that lead to the development of the condition, a new study published by the journal Gut in collaboration with the British Society of Gastroenterology explored the impact of antibiotics on the intestinal flora. The data reveal that cumulative lifelong use of these drugs increases the risks of serious intestinal problems, such as ulcerative colitis and Crohn’s disease.

Using data from the Danish national prescription register, the research followed a population group of Danish residents between 2000 and 2018. More than 6 million individuals aged 10 and over who had not been previously diagnosed IBD were included in the sample and divided by age group. In total, nearly 91% received at least one course of antibiotics during the time the information was collected. During the study, there were 36,017 new cases of ulcerative colitis and 16,881 of Crohn’s disease.

In the study, each course of antibiotics contributed to the time at risk 1 to 5 years after exposure. “We included a range to ensure, as best we could, that the antibiotics used weren’t for symptoms of undiagnosed inflammatory bowel disease,” explains Adam Faye, one of the study’s authors and MD of Population Health at NYU Langone Health Hospital. , in New York .

Looking at the incidence of IBD in the research team, the scientists concluded that these drugs are associated with an increased likelihood of developing diseases affecting the gut: ‘We hypothesized that this may be caused by changes in the gut microbiome, resulting from the use of antibiotics,” he concludes.

Protection

Nayara Carvalho, gastroenterologist at the Sírio Libanês hospital in Brasilia, explains that the development of inflammatory bowel disease is associated with certain risk factors, such as genetic predisposition and changes in the microbiota, a process that can be triggered by the use of antibiotics: ” When you use an antibiotic, it has the role of destroying the bad bacteria, but it can end up destroying the good bacteria, which also protect the gut,” he explains. “This disorganization of the bacterial flora can reduce the protective factor of the gut and disrupt the patient’s immune system, contributing to the inflammatory process.”

According to the collected data, the greatest risk of developing IBD was observed after the use of classes of antibiotics frequently prescribed to treat gastrointestinal pathogens. Bernardo Martins, gastroenterologist at Santa Lúcia Hospital and member of the Brazilian Society of Gastroenterology, explains that this happens because the bacteria present in the intestine also act as a protective factor, helping digestion and protecting against certain diseases. “When we use an antibiotic that kills the bacteria in the gastrointestinal tract, our immune system, which is there to attack only the aggressive factors, starts affecting the organ itself.”

self-attack of the organism

“Inflammatory bowel disease (IBD) is a chronic condition that occurs, as the name suggests, with inflammation of the intestine. The behavior of these diseases is very similar to what we call autoimmune diseases, in which the body begins to attack certain tissues of the body itself. It is as if it creates an antibody against itself, and this is what will generate the inflammatory process. The most important IBDs are Crohn’s disease and ulcerative colitis. In the former, inflammation can occur in any segment intestine, but it is most common at the end of the small intestine, which we call the terminal ileum, and in the right colon.Ulcerative colitis affects the large intestine, which includes the colon and rectum.

Nayara Salgado Carvalho, gastroenterologist at the Sírio Libanês Hospital in Brasilia

* Intern under the supervision of Carmen Souza

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self-attack of the organism

    (credit: personal archive)


credit: Personal Archive

“Inflammatory bowel disease (IBD) is a chronic condition that occurs, as the name suggests, with inflammation of the intestine. The behavior of these diseases is very similar to what we call autoimmune diseases, in which the body begins to attack certain tissues of the body itself. It is as if it creates an antibody against itself, and this is what will generate the inflammatory process. The most important IBDs are Crohn’s disease and ulcerative colitis. In the former, inflammation can occur in any segment intestine, but it is most common at the end of the small intestine, which we call the terminal ileum, and in the right colon.Ulcerative colitis affects the large intestine, which includes the colon and rectum.

Nayara Salgado Carvalho, gastroenterologist
from the Syrian-Lebanese hospital
in Brasilia

Environmental factors are decisive

The study published in the journal Gut shows that, among young adults, genetics is more decisive. However, in people over the age of 40, where the risk of developing inflammatory bowel disease (IBD) was higher, the environmental factor appears to be more of a lifelong determinant. “As the individual ages, the intestinal microbiota automatically changes, and this can lead to a change in the diversity of the intestinal bacterial microflora and an increase in the susceptibility to inflammation of the intestine,” explains Nayara Carvalho, gastroenterologist at the Hospital Sírio Libanês of Brasilia.

Bernardo Martins, of the Santa Lúcia hospital, also believes that constant exposure to antibiotics throughout life plays an important role in the onset of diseases affecting the intestine. “Elderly people, who already have more mature intestinal immune systems, also experienced more bacterial intestinal infections, used more antibiotics and suffered from more aggressive factors. Thus, they are more likely to develop inflammatory bowel disease.”

triggers

In addition to age, the greatest risk of developing IBD was seen in the first two years after exposure to antibiotics. “Immediately after use, this imbalance of the bacterial microflora already occurs. Which can alter the immune system and intestinal permeability, leading to the inflammatory process,” comments Nayara. “But while this happens most frequently in the first two years after use, if this patient continues to take several courses of antibiotics throughout their life, they will have different triggers.”

Adam Faye, author of the study, says more research is needed to confirm the relationship between antibiotic use and the development of inflammation in the gut. For the researcher and the doctors in the area, however, the data already warns of the need for greater awareness on the use of this drug. “The more you use the antibiotic, the more your intestinal flora is reduced. The fewer agents in the microbiota, the higher the possibility of developing an inflammatory disease. Therefore, it is important to always use the antibiotic only when it is very indicated,” reinforces Bernardo Martins. (FF)

Intern under the supervision of Carmen Souza


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