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JOURNAL: Gut 2004;53:246-250.
AUTHORS: Dr. Tim Card
ABSTRACT: Antibiotic use is associated with the subsequent development of Crohn's disease.
COMMENTARY: Genetic factors are recognized as playing a role in Crohn's disease, but other elements must be involved to account for the rise in incidence over the last century.
Since intestinal flora is associated with Crohn's disease, Dr. Card's group surmised that antibiotics, by interfering with normal colonization, may be one of the missing components in disease etiology. They therefore analyzed data from the General Practice Research Database, where antibiotic use had been prospectively recorded.
They identified 587 patients with Crohn's disease for whom data had been recorded for at least 5 years prior to diagnosis, with whom the authors matched 1460 control subjects by age and gender.
Antibiotics were prescribed at least once 2 to 5 years before the index date for 71% of cases and 58% of controls (p < 0.001). In multivariate analysis excluding subjects with symptoms suggestive of Crohn's disease and those prescribed a gastrointestinal drug 2 to 5 years before the index date, the odds ratio was 1.53. This, according to Dr. Card's team, "is evidence against the association being a result of reverse causation.
The authors estimate that the population attributable fraction was 17% for antibiotics, versus 10% for smoking, another recognized risk factor for Crohn's disease.