Inflammatory Bowel Disease And Antibiotics: Gastroenterologist Explains The Link Between The Two

Non-steroidal anti-inflammatory drugs (NSAID) and antibiotics can trigger IBD. But antibiotic usage is important in some situations in IBD.

Inflammatory bowel disease or IBD is a common term used by doctors. But what exactly is it? Basically, it includes 2 different yet related diseases, Ulcerative Colitis and Crohn’s Disease.

In Ulcerative Colitis, there is inflammation and sores or ulcers along the lining of the large intestine and rectum. In Crohn’s Disease, the inflammation of the lining of the digestive tract can also involve the deeper layers of the digestive tract. Though it is mostly confined to the small intestine, in rare cases, it can also affect the large intestine and the upper gastrointestinal tract. You need to consult a doctor if you experience Diarrhea, Rectal bleeding, Abdominal pain, Fatigue, Weight loss and Loss of appetite for no reason as these are the warning signs of IBD

IBD Triggers

Though experts are divided as to the exact cause of IBD, all agree that the following factors may play a role in the development of this disease.

The environment
Diet
Certain medications
Genetic variables
Severe autoimmune response against normal bacteria in the gut.

Can antibiotics up your risk?

According to a study conducted by researchers from Karolinska Institutet in Sweden and Harvard Medical School in the US, antibiotics use, especially those with greater spectrum of microbial coverage, may increase the risk of new-onset inflammatory bowel disease in patients. This was published in the journal The Lancet Gastroenterology & Hepatology.

To get a better understanding on the link between inflammatory bowel disease and antibiotics, today, on the occasion of World Inflammatory Bowel Disease Day, we reached out to Dr B Ravi Shankar, Consultant Medical Gastroenterologist, Yashoda Hospitals Hyderabad. According to him, “There is some evidence that elderly patients receiving several courses of antibiotics are predisposed to IBD. There is also some suspicion for the occurrence of Crohn’s Disease (CD) in children exposed to antibiotics. The strength of association of antibiotics and IBD is more for CD rather than for Ulcerative Colitis (UC).” Dr Shankar also brings our focus to the following pointers:

Antibiotics are needed in some situations in IBD patients.
Antibiotics are the treatment of Pouchitis, a complication after surgery in IBD.
There are postulations of antibiotics triggering IBD (UC, CD); but this needs to be substantiated.
Antibiotics cause dysbiosis of the colonic flora and may lead to initiation of gut inflammation and perpetuation in susceptible individuals.

Importance of antibiotics in IBD treatment

According to Dr Shankar, the actual cause of IBD is not known and he says that various mechanisms involved could be genetic, environmental, drugs, auto immunity, gut microbes and hygiene. He also says that among drugs, non-steroidal anti-inflammatory drugs (NSAID) and antibiotics are incriminated in its development. However, he also clarifies that antibiotic usage is important in some situations in IBD. It may be needed in the following cases:

During relapse of IBD, C.difficile may have to be treated by Vancomycin, metronidazole or Rifaximin.
Infective complications like perianal abscess, intra-abdominal abscess in IBD
Treatment of Pouchitis.

The last word

Speaking further on the link between IBD and antibiotics, Dr Shankar says, “There should be a judicious use of antibiotics in any situations so that organisms do not become resistant to the drugs and also consideration to be given to chronic disorders like IBD while may be provoked by the usage of these drugs. At this time, it can be said that the association of antibiotic usage & IBD exists, but it is not the only reason or single cause of IBD, which requires multiple factors to manifest.”