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Published on: November 17, 2018
Early life antibiotics and childhood gastrointestinal disorders: a systematic review
Kim Kamphorst1,2, Emmy Van Daele3, Arine M Vlieger2
1Pediatrics, Amsterdam Gastroenterology, Metabolism & Nutrition, Amsterdam Reproduction & Development Amsterdam, Amsterdam UMC Location AMC, Amsterdam, The Netherlands.
Insights
Early antibiotic exposure in children is linked to increased risks of developing gastrointestinal disorders like IBD and celiac disease later in childhood. Judicious antibiotic use in early life is recommended.
Area of Science:
- Pediatric Gastroenterology
- Microbiome Research
- Pharmacoepidemiology
Background:
- Growing evidence links antibiotic use to gastrointestinal (GI) disorders in adults.
- Limited research exists on this association in pediatric populations.
- Understanding early-life antibiotic impact on children's GI health is crucial.
Purpose of the Study:
- To assess the association between early-life antibiotic exposure (first 2 years) and chronic GI disorders in children.
- To synthesize existing evidence on antibiotic use and pediatric GI conditions.
Main Methods:
- Systematic review of MEDLINE, Embase, WHO trial register, and Web of Science.
- Inclusion of 22 studies (11 cohort, 11 case-control) with independent screening and quality assessment.
- Examination of associations with inflammatory bowel disease (IBD), eosinophilic oesophagitis (EoE), coeliac disease (CeD), and functional GI disorders.
Main Results:
- Strong evidence links early antibiotic exposure to childhood IBD and CeD.
- Moderate evidence suggests an association with EoE.
- No significant association found with functional constipation in the first year; insufficient evidence for other disorders.
Conclusions:
- Early-life antibiotic use may elevate the risk of developing GI disorders later in childhood.
- Further research is needed to elucidate mechanisms and develop preventive strategies.
- Judicious antibiotic administration in early childhood is strongly advised.
Background:
In adults, there is increasing evidence for an association between antibiotic use and gastrointestinal (GI) disorders but in children, the evidence is scarce.
Objective:
Assess the association between exposure to antibiotics in the first 2 years of life in term born children and the presence of chronic GI disorders later in childhood.
Design:
For this systematic review the MEDLINE, Embase, WHO trial register and Web of Science were systematically searched from inception to 8 June 2020. Title and abstract screening (n=12 219), full-text screening (n=132) as well as the quality assessment with the Newcastle-Ottawa Scale were independently performed by two researchers.
Main Outcome Measures:
The association between antibiotics and inflammatory bowel disease (IBD) (n=6), eosinophilic oesophagitis (EoE) (n=5), coeliac disease (CeD) (n=6), infantile colics (n=3), functional constipation (n=2), recurrent abdominal pain, regurgitation, functional diarrhoea and infant dyschezia were examined.
Results:
Twenty-two studies were included, 11 cohort and 11 case-control studies. A best evidence synthesis showed strong evidence for an association between antibiotic exposure in the first 2 years of life and the presence of IBD, and CeD during childhood. Moderate evidence was found for an association with EoE and no association with functional constipation in the first year of life. There was insufficient evidence for the other studied disorders.
Conclusions:
The use of antibiotics in early life may increase the risk of GI disorders later in life. Further studies are necessary to unravel the underlying mechanisms and determine potential preventive measures. Meanwhile judicious use of antibiotics in early childhood is highly warranted.
Prospero Registration Number:
PROSPERO CRD42019132631.
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