Background & Aims

Laboratory studies have demonstrated that antibiotic use in conjunction with bowel purgatives causes alterations to the gut microbiota. Because gut microbiota changes may be a trigger for the development of irritable bowel syndrome (IBS), we sought to assess whether individuals who undergo bowel cleansing for colonoscopy and have concurrent antibiotic exposure develop IBS at higher rates than individuals who undergo colonoscopy without antibiotic exposure.

Methods

We used data from Optum’s de-identified Clinformatics Data Mart Database in the United States to study a cohort of 50- to 55-year-olds who underwent screening colonoscopy. Individuals exposed to antibiotics within 14 days of colonoscopy were propensity-score matched to individuals who were not exposed to antibiotics around colonoscopy. The primary outcome was a new IBS diagnosis, and the composite outcome was a new claim for IBS, IBS medications, or IBS symptoms. The association of antibiotic exposure and the outcomes was calculated using Cox proportional hazards regression.

Results

There were 408,714 individuals who met criteria for the screening colonoscopy cohort. Of these, 24,617 (6.0%) were exposed to antibiotics around the time of colonoscopy, and they were propensity-score matched to 24,617 individuals not exposed to antibiotics. There was no statistically significant association between antibiotic use and IBS (hazard ratio, 1.11; 95% confidence interval, 0.89–1.39), but there was a weak association between antibiotic use and the composite outcome (hazard ratio, 1.12; 95% confidence interval, 1.02–1.24; number needed to harm, 94).

Conclusions

Individuals concurrently exposed to antibiotics and bowel purgative had slightly higher rates of surrogate IBS outcomes compared with matched controls who did not receive antibiotics concurrently with bowel purgative.

中文翻译：

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暴露和未暴露抗生素的患者结肠镜检查后肠易激综合征的风险：一项回顾性队列研究

背景与目标

实验室研究表明，抗生素与肠道泻药联合使用会导致肠道微生物群发生改变。由于肠道微生物群的变化可能是肠易激综合征 (IBS) 发展的诱因，我们试图评估接受结肠镜检查肠道清洁并同时接触抗生素的个体是否比接受结肠镜检查但未接触抗生素的个体发生 IBS 的几率更高。

方法

我们使用来自美国 Optum 去识别化的临床信息学数据集市数据库的数据来研究一组接受结肠镜筛查的 50 至 55 岁人群。在结肠镜检查后 14 天内接触抗生素的个体与结肠镜检查前后未接触抗生素的个体进行倾向评分匹配。主要结果是新的 IBS 诊断，复合结果是 IBS、IBS 药物或 IBS 症状的新索赔。使用 Cox 比例风险回归计算抗生素暴露与结果的关联。

结果

共有 408,714 人符合结肠镜筛查队列的标准。其中，24,617 人 (6.0%) 在结肠镜检查期间接触过抗生素，并且他们与未接触过抗生素的 24,617 人进行了倾向评分匹配。抗生素使用与 IBS 之间无统计学显着关联（风险比 1.11；95% 置信区间 0.89–1.39），但抗生素使用与综合结果之间的关联微弱（风险比 1.12；95% 置信区间, 1.02–1.24；伤害所需的数量，94)。

结论

与未同时接受抗生素和肠道泻药的匹配对照相比，同时接触抗生素和肠道泻药的个体的替代 IBS 结果发生率略高。