Associations of Antibiotics, Hormonal Therapies, Oral Contraceptives, and Long-Term NSAIDS With Inflammatory Bowel Disease: Results From the Prospective Urban Rural Epidemiology (PURE) Study

Neeraj Narula, Emily C.L. Wong, Cara Pray, John K. Marshall, Sumathy Rangarajan, Shofiqul Islam, Ahmad Bahonar, Khalid F. Alhabib, Anna Kontsevaya, Farnaza Ariffin, Homer U. Co, Wadeia Al Sharief, Andrzej Szuba, Andreas Wielgosz, Maria Luz Diaz, Rita Yusuf, Lanthé Kruger, Biju Soman, Yang Li, Chuangshi WangLu Yin, Erkin Mirrakhimov, Fernando Lanas, Kairat Davletov, Annika Rosengren, Patricio Lopez-Jaramillo, Rasha Khatib, Aytekin Oguz, Romaina Iqbal, Karen Yeates, Álvaro Avezum, Walter Reinisch, Paul Moayyedi, Salim Yusuf

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)

Abstract

Background & Aims: Several medications have been suspected to contribute to the etiology of inflammatory bowel disease (IBD). This study assessed the association between medication use and the risk of developing IBD using the Prospective Urban Rural Epidemiology cohort. Methods: This was a prospective cohort study of 133,137 individuals between the ages of 20 and 80 from 24 countries. Country-specific validated questionnaires documented baseline and follow-up medication use. Participants were followed up prospectively at least every 3 years. The main outcome was the development of IBD, including Crohn's disease (CD) and ulcerative colitis (UC). Short-term (baseline but not follow-up use) and long-term use (baseline and subsequent follow-up use) were evaluated. Results are presented as adjusted odds ratios (aORs) with 95% CIs. Results: During a median follow-up period of 11.0 years (interquartile range, 9.2–12.2 y), there were 571 incident IBD cases (143 CD and 428 UC). Incident IBD was associated significantly with baseline antibiotic (aOR, 2.81; 95% CI, 1.67–4.73; P =.0001) and hormonal medication use (aOR, 4.43; 95% CI, 1.78–11.01; P =.001). Among females, previous or current oral contraceptive use also was associated with IBD development (aOR, 2.17; 95% CI, 1.70–2.77; P <.001). Nonsteroidal anti-inflammatory drug users also were observed to have increased odds of IBD (aOR, 1.80; 95% CI, 1.23–2.64; P =.002), which was driven by long-term use (aOR, 5.58; 95% CI, 2.26–13.80; P <.001). All significant results were consistent in direction for CD and UC with low heterogeneity. Conclusions: Antibiotics, hormonal medications, oral contraceptives, and long-term nonsteroidal anti-inflammatory drug use were associated with increased odds of incident IBD after adjustment for covariates.

Original languageEnglish
Pages (from-to)2649-2659.e16
JournalClinical Gastroenterology and Hepatology
Volume21
Issue number10
DOIs
Publication statusPublished - Sept 2023

Keywords

  • Antibiotics
  • Crohn's Disease
  • Estrogen
  • Hormone
  • IBD
  • NSAIDS
  • Oral Contraceptive
  • Ulcerative Colitis

Fingerprint

Dive into the research topics of 'Associations of Antibiotics, Hormonal Therapies, Oral Contraceptives, and Long-Term NSAIDS With Inflammatory Bowel Disease: Results From the Prospective Urban Rural Epidemiology (PURE) Study'. Together they form a unique fingerprint.

Cite this