Lower body image of woman with stomach pain, holding stomach in bathroom

Antibiotics are linked to a higher risk of inflammatory bowel disease (IBD) among older adults, a study from Denmark has found. Clinicians should keep the condition in mind when evaluating older patients with gastrointestinal distress, investigators say.

IBD involves debilitating, chronic inflammation of the digestive tract and includes ulcerative colitis and Crohn’s disease. In the new study, investigators examined data from 2.3 million older adults with the condition. They found that the odds of diagnosis with IBD rose with each course of antibiotics, no matter the class of drug. With one course, seniors were 27% more likely to have IBD, when compared to patients with no recent antibiotics use. By four courses, the risk rose to 96%. 

At five or more courses of antibiotics, seniors had more than double the odds of new IBD diagnoses when compared to their peers who had been prescribed no antibiotics in the previous five years, the researchers reported. The risk was greater with more recent prescriptions, between one to two years earlier. But the increased likelihood of an IBD diagnosis lasted five years, they added. (Prescriptions within one year of diagnosis were omitted from the study).

These effects were tied to all antibiotics with the exception of nitrofurantoin, a drug commonly prescribed for treating urinary tract infections. 

The takeaway? In addition to practicing careful antibiotic stewardship, clinicians should take care not to overlook or dismiss IBD as a cause when older patients complain of new gastroenterological symptoms, the authors wrote.

“When you look at younger patients with new diagnoses of Crohn’s disease and ulcerative colitis, there’s generally a strong family history,” Adam S. Faye, M.D., of New York University, said in a statement. “But that is not the case in older adults, so it’s really something in the environment that is triggering it.” 

Full findings were published in the Journal of Crohn’s and Colitis, and will be presented at Digestive Disease Week 2022, which runs from May 21 to May 24.  

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