The role of antibiotic exposure as risk factor for IBD epidemic: an updated meta-analysis

The rising prevalence of IBD globally has raised concerns about antibiotic exposure. This study's meta-analysis examines antibiotic exposure, frequency, year before diagnosis, regional differences, and IBD incidence.

The literature review used PubMed, Web of Science, Elsevier, ScienceDirect, and Cochrane CENTRAL databases up to June 2024 to explore the link between antibiotic exposure and IBD risk. Stratified analysis was conducted by years of antibiotic exposure before IBD diagnosis, frequency, and region. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were combined using a random effects model.

Eighteen case-control studies and five cohort studies were included (n = 99, 104 IBD patients and n = 2 273 336 controls). The findings indicate that antibiotic exposure significantly has a positive association with the risk of developing IBD (OR, 1.66; 95% CI, 1.28-2.16). Antibiotic exposure of ≥3 years (OR, 1.49; 95% CI, 1.12-1.98), 2 years (OR, 1.46; 95% CI, 1.37-1.55), and ≤1 year (OR, 1.55; 95% CI, 1.17-2.04) prior to the diagnosis of IBD is associated with a higher risk of developing IBD. Cumulative exposure of ≥3 dispensations (OR, 2.02; 95% CI, 1.49-2.74) and two dispensations (OR, 1.36; 95% CI, 1.03-1.78) also had a positive association with IBD risk, while one dispensation did not (OR, 0.96; 95% CI, 0.72-1.26). No significant association was found in developing countries (OR, 1.92; 95% CI, 0.71-5.19), but developed countries showed a significant positive association with the risk (OR, 1.58; 95% CI, 1.27-1.96).

The meta-analysis suggests that antibiotic use has a positive association with the risk of IBD, and limiting unnecessary antibiotic use may be one way to reduce the risk of developing IBD.