Antibiotics and risk of new onset inflammatory bowel disease a meta analysis
This presentation is the property of its rightful owner.
Sponsored Links
1 / 21

Antibiotics and Risk of New Onset Inflammatory Bowel Disease: A Meta-Analysis PowerPoint PPT Presentation


  • 77 Views
  • Uploaded on
  • Presentation posted in: General

Antibiotics and Risk of New Onset Inflammatory Bowel Disease: A Meta-Analysis. Ryan Ungaro 1 , Charles Bernstein 2 , Richard Gearry 3 , Anders Hviid 4 , Kaija-Leena Kolho 5 , Matthew Kronman 6 , Souradet Shaw 2 , Herbert Van Kruiningen 7 , Jean-Frédéric Colombel 1 , Ashish Atreja 1

Download Presentation

Antibiotics and Risk of New Onset Inflammatory Bowel Disease: A Meta-Analysis

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Antibiotics and risk of new onset inflammatory bowel disease a meta analysis

Antibiotics and Risk of New Onset Inflammatory Bowel Disease: A Meta-Analysis

Ryan Ungaro1, Charles Bernstein2, Richard Gearry3, Anders Hviid4, Kaija-Leena Kolho5, Matthew Kronman6, Souradet Shaw2, Herbert Van Kruiningen7, Jean-Frédéric Colombel1, Ashish Atreja1

2013 CCFA Advances in Inflammatory Bowel Diseases Conference

1. Ichan School of Medicine at Mount Sinai, New York, NY

2. University of Manitoba, Winnipeg, Canada

3. University of Otago, Christchurch, New Zealand

4. Statens Serum Institut, Coopenhagen, Denmark

5. University of Helsinki, Helsinki, Finland

6. Seattle Children’s Hospital, Seattle, Washington

7. University of Connecticut, Storrs, Connecticut


Disclosures

Disclosures

Nothing to Disclose


Background

Background

Medications emerging as risk factor for IBD

Antibiotics may increase risk of CD and UC1

However some studies have found no association2,3

Few studies have reported risk associated with specific antibiotic classes

1. De Vroey et al. Am J Gastroenterol. 2010;105(12)

2. Castiglione F et al. J Crohns Colitis. 2012;6(3)

3. Van Kruiningen et al. Inflamm Bowel Dis. 2005;11(4)


Study aims

Study Aims

1. To examine antibiotic use as a risk factor for new onset IBD, CD and UC

2. To evaluate if effect of antibiotics different in children versus adults

3. To determine IBD risk with specific antibiotic classes


Methodology

Methodology

Meta-analysis of Observational Studies in Epidemiology (MOOSE)1

Search strategy

Medline, Embase and Cochrane databases

Search keywords:

Inflammatory bowel disease, Crohn’s disease, ulcerative colitis, antibiotics, penicillin, cephalosporin, tetracycline, fluoroquinolone, macrolide, sulfonamide, metronidazole

1. Stroup DF, et al. JAMA 2000;283.


Methodology1

Methodology

Inclusion criteria

Cohort or case-control

Data on exposure to antibiotics prior to new diagnosis of IBD (CD, UC, or both)

Data collection

Two reviewers extracted data

Authors contacted if data not available in published manuscript (7 studies)

Data analysis

Random-effects model to determine overall pooled estimates and 95% confidence intervals (CI)

The Newcastle-Ottawa Scale (NOS) to assess study quality1

1. Wells et al. Accessed at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.


Search results

Search Results

4508 Citations Retrieved

2558 from Pubmed

1798 from Embase

149 from Cochrane

3 from Backward Snowballing

1234 Review Articles Excluded

3274 Original Articles

3259 Articles Excluded by Title and Abstract Review

5 Studies Excluded After Full Text Review

  • 3 used surrogate for antibiotic use

  • 1 without controls

  • 1 insufficient data available

16 Original Articles

11 Articles Included

  • 8 Case-Control

  • 3 Cohort


Case control studies

Case-Control Studies

* provided extra data

Pediatric studies highlighted

1. Wells et al. Accessed at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.


Cohort studies

Cohort Studies

* provided extra data

Pediatric studies highlighted

IBDU = IBD, type unclassified

1. Wells et al. Accessed at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.


Included studies

Included Studies

  • 11 total studies with 7,208 patients diagnosed with IBD

    • 3,937 patients with CD

    • 3,207 patients with UC

    • 64 patients with IBDU

  • Majority studies (9 of 11)explicitly excluded some time period prior to new diagnosis of IBD

    • Range from 3.9 months to 4 years

    • Limit confounding by diagnostic delay

IBDU = IBD, type unclassified


Antibiotic exposure associated with increased overall risk of new onset ibd

Antibiotic exposure associated with increased overall risk of new onset IBD

(CD)

(UC)

I2 = 82.35, p = 0.00


Antibiotic exposure and risk of new onset ibd in adults and children

Antibiotic exposure and risk of

new onset IBD in adults and children

Adults

OR 1.431

(95% CI 1.116-1.834)

I2 = 90.07, p = 0.00

Children

OR 1.894

(95% CI 1.237-2.989)

(CD)

(UC)

I2 = 48.78, p = 0.099

I2 = 48.78, p = 0.099


Antibiotic exposure associated with increased risk of new onset cd

Antibiotic exposure associated with increased risk of new onset CD

I2 = 84.87, p = 0.00


Antibiotic exposure and risk of new onset cd in adults and children

Antibiotic exposure and risk of

new onset CD in adults and children

Adults

OR 1.565

(95% CI 1.177-2.081)

I2 = 89.97, p = 0.00

Children

OR 2.747

(95% CI 1.723-4.379)

I2 = 0.00, p = 0.63


Antibiotic exposure not associated with increased risk of new onset uc

Antibiotic exposure NOT associated with increased risk of new onset UC

I2 = 47.41, p = 0.07


Antibiotic exposure and risk of new onset uc in adults and children

Antibiotic exposure and risk of

new onset UC in adults and children

Adults

OR 1.058

(95% CI 0.851-1.316)

I2 = 72.71, p = 0.012

Children

OR 1.112

(95% CI 0.773-1.602)

I2 = 0.00, p = 0.87


Most classes of antibiotics are associated with increased risk of new onset ibd

Most classes of antibiotics are associated with increased risk of new onset IBD


Limitations

Limitations

Data compiled from retrospective studies

Questionnaire studies subject to recall bias

Range in the quality of studies (based on QOS scale)

Significant heterogeneity in certain analyses

Different antibiotic exposure exclusion time periods


Summary

Summary

Antibiotic exposure increases odds of new diagnosis IBD

Antibiotic use increases risk new onset CD but not UC

CD risk greatest in children

Most antibiotic classes associated with IBD

Penicillin not associated

Metronidazole and quinolones most strongly associated


Discussion

Discussion

  • Antibiotics may increase IBD risk by altering microbiome

  • Alternatively, association may be surrogate marker for increased risk infections in CD

1. Manichanh C et al.Nat Rev Gastroenterol Hepatol. 2012;;9(10).

2. Perez-Cobas et al. Gut. 2013; 62(11).

3. Gradel KO et al. Gastroenterology. 2009;137.


Thank you

Thank You

Ashish Atreja

Jean-Frederic Colombel

Charles Bernstein

Richard Gearry

Anders Hviid

Kaija-Leena Kolho

Matthew Kronman

Souradet Shaw

Herbert Van Kruiningen

Crohn’s and Colitis Foundation of America


  • Login