Data link Crohn's disease, antibiotics

Use of antibiotics is a potential risk factor for the development of Crohn's disease, according to a paper published in the February issue of the journal Gut.

Researchers at England's University of Nottingham and Cambridge University analyzed the British General Practice Research Database for information about antibiotic use of those with and without the disease. The database includes information about diagnosing and prescribing practices of 5% of the nation's physicians and is considered to be one of the world's largest computerized databases of longitudinal anonymous patient medical records from this setting.

The researchers found that those with Crohn's received twice as many prescriptions over a five-year period and were 30% more likely to have been prescribed antibiotics.

Although Crohn's disease is primarily regarded as a genetic condition, researchers have been hunting for environmental reasons why the disease has increased significantly over the past few decades. Antibiotics are just one of many environmental triggers being scrutinized, along with factors such as appendectomies, the birth control pill, and smoking.

"Finding the environmental trigger is the million dollar question," said Subra Kugaphasan, MD, a pediatric gastroenterologist at the Medical College of Wisconsin in Milwaukee.

Researchers conceded that antibiotic use may be due in part to patients hunting for relief from symptoms before receiving a definitive diagnosis.

"Our data provide some support for antibiotic exposure playing a role, but we now need other studies particularly in children and looking at antibiotic use early in life," said Dr. Richard Logan one of the authors and a professor of clinical epidemiology at the University of Nottingham.

Experts said that although the study was provocative, the numbers did not seem strong enough to draw its conclusion even if they did reach statistical significance. Experts did say that studies like this should give physicians additional pause when it comes to prescribing antibiotics.

"Here is another condition that should make all physicians circumspect with regard to the application of antibiotics unless it's truly indicated," said Marvin L. Corman, MD, vice chair of surgery at North Shore-Long Island Jewish Medical Center in New York.