Antibiotic Use During Gastrointestinal Infections Increases the Risk of Developing Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis.
Luigi Colecchia, Giovanni Marasco, Cecilia Capelli et al.
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In 30 seconds
This systematic review and meta-analysis examined new irritable bowel syndrome (IBS) diagnoses among people with documented antibiotic exposure compared with unexposed controls. Across 31 studies involving 422,350 patients, pooled IBS incidence was 26% in antibiotic users and 20% in nonusers; the incidence rate ratio was 1.3 (95% CI: 1.07-1.58; P = 0.008). In analyses limited to antibiotics used for gastrointestinal infections, the association was stronger (IRR: 1.71; 95% CI: 1.16-2.51; P = 0.007), although study heterogeneity was high.
Key findings
- Across 31 studies, pooled IBS incidence was 26% in antibiotic users versus 20% in nonusers (IRR: 1.3; 95% CI: 1.07-1.58; P = 0.008).
- For antibiotics used during gastrointestinal infections, the pooled IRR for IBS was 1.71 (95% CI: 1.16-2.51; P = 0.007).
- Heterogeneity was high in the gastrointestinal-infection sensitivity analysis (I2 > 90%); geography, IBS diagnostic criteria, and study quality were associated with estimated effects.
Why it matters
The findings suggest that antibiotic exposure, particularly during gastrointestinal infections, may be associated with subsequent IBS diagnoses. This is clinically relevant because it highlights a possible longer-term outcome to consider when interpreting antibiotic exposure and post-infectious symptoms. However, the substantial variation between studies means the pooled estimates should be interpreted cautiously and do not establish that antibiotics cause IBS.
What to keep in mind
The evidence is heterogeneous, with high heterogeneity in the gastrointestinal-infection analysis; the authors state that this reduces the power of the results.