- Fecal Incontinence
|Antibiotics in the pathogenesis of diabetes and inflammatory diseases of the gastrointestinal tract
Nat Rev Gastroenterol Hepatol. 2022 Oct 18. doi: 10.1038/s41575-022-00685-9.Online ahead of print.
1Department of Clinical and Experimental Vascular Medicine, Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
2Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism (AGEM), Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
3Department of Paediatrics, Rutgers University, New Brunswick, NJ, USA.
4Department of Medicine, Rutgers University, New Brunswick, NJ, USA.
5Department of Medicine, Rutgers University, New Brunswick, NJ, USA. firstname.lastname@example.org.
6Department of Pathology and Laboratory Medicine, Rutgers University, New Brunswick, NJ, USA. email@example.com.
Antibiotic use is increasing worldwide. However, the use of antibiotics is clearly associated with changes in gut microbiome composition and function, and perturbations have been identified as potential environmental risk factors for chronic inflammatory disorders of the gastrointestinal tract. In this Review, we examine the association between the use of antibiotics and the onset and development of both type 1 and type 2 diabetes, inflammatory bowel disease, including ulcerative colitis and Crohn's disease, as well as coeliac disease and eosinophilic oesophagitis. We discuss the key findings of epidemiological studies, provide mechanistic insights into the pathways by which the gut microbiota might contribute to these diseases, and assess clinical trials investigating the effects of antibiotics. Such studies indicate that antibiotic exposures, varying in type, timing and dosage, could explain differences in disease risk. There seems to be a critical window in early life in which perturbation of the microbiome has a substantial effect on disease development. Identifying the antibiotic-perturbed gut microbiota as a factor that contributes to the pathophysiology of these inflammatory disorders might stimulate new approaches to prevention, diagnosis and treatment.