The association between antibiotic exposure and inflammatory bowel disease (IBD) remains controversial, especially whether there is a dose-response relationship. We aimed to conduct a systematic review and meta-analysis to thoroughly evaluate the risk of new-onset IBD associated with antibiotic exposure. Four databases were searched from their inception to September 30, 2023 for all relevant studies. The risk estimates were pooled together using random-effects models, and pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, stratified by IBD subtype, age, exposure period, study type, and antibiotic classes. Dose-response relationship between the number of antibiotic prescriptions and IBD risk was assessed using generalized least squares regression analysis. Twenty-eight studies involving 153,027 patients with IBD were included. Antibiotic exposure was significantly associated with an increased risk of new-onset IBD for prescription-based studies (pooled OR, 1.41; 95% CI, 1.29–1.53) and for questionnaire-based studies (pooled OR, 1.35; 95% CI, 1.08–1.68). This association existed for both Crohn’s disease and ulcerative colitis, as well as in children and adults for prescription-based studies. The majority of antibiotic classes were associated with an increased IBD risk, with metronidazole (OR, 1.70; 95% CI, 1.38–2.10) and quinolones (OR, 1.56; 95% CI, 1.37–1.77) having relatively higher risk estimates. A positive nonlinear dose-response association was observed between the number of antibiotic prescriptions and IBD risk. Antibiotic exposure was significantly associated with an increased risk of new-onset IBD, and a positive nonlinear dose-response relationship was observed. Antibiotic stewardship may be important for reducing IBD risk.

中文翻译：

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抗生素暴露和新发炎症性肠病的风险：系统评价和剂量反应荟萃分析

抗生素暴露与炎症性肠病（IBD）之间的关联仍存在争议，特别是是否存在剂量反应关系。我们的目的是进行系统评价和荟萃分析，以彻底评估与抗生素暴露相关的新发 IBD 风险。检索了四个数据库从成立到 2023 年 9 月 30 日的所有相关研究。使用随机效应模型将风险估计汇总在一起，并计算具有 95% 置信区间 (CI) 的汇总比值比 (OR)，并按 IBD 亚型、年龄、暴露时间、研究类型和抗生素类别进行分层。使用广义最小二乘回归分析评估抗生素处方数量与 IBD 风险之间的剂量反应关系。纳入了 28 项研究，涉及 153,027 名 IBD 患者。对于基于处方的研究（汇总 OR，1.41；95% CI，1.29–1.53）和基于问卷的研究（汇总 OR，1.35；95% CI，1.08），抗生素暴露与新发 IBD 风险增加显着相关。 –1.68）。这种关联在克罗恩病和溃疡性结肠炎中都存在，在基于处方的研究中也存在于儿童和成人中。大多数抗生素类别与 IBD 风险增加相关，其中甲硝唑（OR，1.70；95% CI，1.38–2.10）和喹诺酮类（OR，1.56；95% CI，1.37–1.77）的风险估计相对较高。抗生素处方数量与 IBD 风险之间观察到呈正非线性剂量反应关系。抗生素暴露与新发 IBD 风险增加显着相关，并且观察到呈正非线性剂量反应关系。抗生素管理对于降低 IBD 风险可能很重要。