Antibiotics: a trigger for inflammatory bowel disease?

The role of the gut microbiota in the pathogenesis of inflammatory bowel disease (IBD) is well established. As well as alterations in gut microbiota composition and functions associated with IBD, the most convincing arguments for this effect are the pro-colitogenic effect of the microbiota of patients with IBD, 1 Britton GJ Contijoch EJ Mogno I et al. Microbiotas from humans with inflammatory bowel disease alter the balance of gut Th17 and RORγt+ regulatory T cells and exacerbate colitis in mice. Immunity. 2019; 50: 212-224 Summary Full Text Full Text PDF PubMed Scopus (118) Google Scholar and modification of the intestinal inflammation phenotype induced by the change of gut microbiota in both mice and human beings, particularly using faecal microbiota transplantation. 2 Paramsothy S Kamm MA Kaakoush NO et al. Multidonor intensive faecal microbiota transplantation for active ulcerative colitis: a randomised placebo-controlled trial. Lancet. 2017; 389: 1218-1228 Summary Full Text Full Text PDF PubMed Scopus (498) Google Scholar , 3 Sokol H Landman C Seksik P et al. Fecal microbiota transplantation to maintain remission in Crohn's disease: a pilot randomized controlled study. Microbiome. 2020; 8: 12 Crossref PubMed Scopus (39) Google Scholar Antibiotic use and the development of inflammatory bowel disease: a national case-control study in SwedenHigher cumulative exposure to systemic antibiotic therapy, particularly treatments with greater spectrum of microbial coverage, may be associated with a greater risk of new-onset IBD and its subtypes. The association between antimicrobial treatment and IBD did not appear to differ when predisposed siblings were used as the reference controls. Our findings, if substantiated by longer-term prospective studies in humans or mechanistic preclinical investigations, suggest the need to further emphasise antibiotic stewardship to prevent the rise in dysbiosis-related chronic diseases, including IBD. Full-Text PDF