Antibiotics after colonoscopy linked with higher risk of subsequent IBS
Antibiotic exposure within 14 days after a screening colonoscopy correlated with an increased chance of subsequent irritable bowel syndrome, according to data from Digestive Disease Week.
“Patients that undergo bowel cleansings in conjunction with their colonoscopy appear to have an increasing risk for developing IBS or IBS symptoms if they are also receiving antibiotics at the time of their bowel cleansing,” Ravy K. Vajravelu, MD, MSCE, instructor of medicine, division of gastroenterology; faculty fellow, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, told Healio Gastroenterology and Liver Disease.
Vajravelu and colleagues assessed 402,259 records from the OptumInsight Clinformatics database of individuals who underwent screening colonoscopy between 2000 and 2016. They recorded antibiotic exposure within 14 days before and up to 14 days after colonoscopy. A new diagnosis of IBS within 180 days after the antibiotic exposure window served as study’s primary outcome. Other outcomes included new diagnoses of abdominal pain, change in bowel habits and diarrhea. Patient demographics, medical comorbidities (chronic kidney disease, depression, diabetes, heart failure, hypertension, hypothyroidism, and obesity), and gastrointestinal infections (cholecystitis, diverticulitis, and H. pylori) were among the covariates of interest.
Multivariable logistic regression adjusted for the covariates was used to assess correlation of antibiotic use with IBS and then backward elimination was used to select significantly correlated covariates.
Investigators found 2% of patients received antibiotics before, 2% received antibiotics after and 1% received antibiotics before and after colonoscopy. After a median of 112 days, 1,002 patients were diagnosed with IBS.
Results from the multivariable regression model demonstrated antibiotic use 14 days after colonoscopy correlated with subsequent diagnosis of IBS (aOR 1.77, 95% CI 1.31-2.39). There was a correlation between antibiotic use in the 14 days before colonoscopy (aOR 1.38, 95% CI 0.99-1.92) and antibiotic use both before and after colonoscopy (aOR 1.41, 95% CI 0.97-2.04), Vajravelu said. He noted age and sex were retained in the final model and the secondary and primary analysis were similar.
“At this preliminary stage, results have not impacted my practice yet,” he said. “If the results hold in the final analyses, I will certainly consider rescheduling elective colonoscopy on patients who are receiving antibiotics.”
These are potentially clinically relevant results, Vajravelu said.
“We are making sure the inclusion and exclusion criteria are as carefully selected as possible,” he said. “We want to make sure that in people getting coloscopies, that antibiotics are not related to their subsequent diagnosis of IBS, but we are not seeing a false signal that the IBS is actually the reason they got the antibiotics in the first place. We want to make sure the combination of the antibiotics and colonoscopy is causing the IBS instead of being the signal; some people just have preexisting IBS symptoms.” – by Monica Jaramillo
Reference: Vajravelu RK, et al. Abstract 404. Presented at: Digestive Disease Week; May 2-5, 2020; Chicago (meeting canceled).
Disclosure: Vajravelu reports no relevant financial disclosures.