Early-Life Infections, Antibiotics and Later Risk of Childhood and Early Adult-Onset Inflammatory Bowel Disease: Pooled Analysis of Two Scandinavian Birth Cohorts Aliment Pharmacol Ther. 2025 Jan;61(2):323-334. doi: 10.1111/apt.18358. Epub 2024 Oct 25. Karl Mårild 1 2, Tereza Lerchova 1, Malin Östensson 3, Henrik Imberg 4 5, Ketil Størdal 6 7, Johnny Ludvigsson 8 9 |
Author information 1Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 2Pediatric Gastroenterology Unit, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden. 3Bioinformatics and Data Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 4Statistiska Konsultgruppen Sweden, Gothenburg, Sweden. 5Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 6Department of Pediatric Research, Faculty of Medicine, University of Oslo, Oslo, Norway. 7Children's Center, Oslo University Hospital, Oslo, Norway. 8Crown Princess Victoria Children's Hospital, Linköping, Sweden. 9Division of Pediatrics, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden. Abstract Background: Childhood antibiotic use has been associated with inflammatory bowel disease (IBD), although the potential contribution of infection frequency remains uncertain. Aims: To explore the association between early-life infections, antibiotics and IBD development. Methods: We used population-based data from ABIS (Sweden) and MoBa (Norway) cohorts following children from birth (1997-2009) until 2021. Prospectively collected questionnaires identified infection frequency (any, gastrointestinal and respiratory) and antibiotics (any, penicillin and non-penicillin) until age 3. IBD diagnosis required ≥ 2 records in national health registries. Cohort-specific hazard ratios (aHR), adjusted for parental education, smoking and IBD were estimated and pooled using a random-effects model. Antibiotic analyses were adjusted for infection frequency. Results: There were 103,046 children (11,872 ABIS and 91,174 MoBa), contributing to 1,663,898 person-years of follow-up, during which 395 were diagnosed with IBD. The frequency of any infection at 0 to < 1 and 1 to < 3 years showed a pooled aHR of 1.01 (95% confidence interval [CI] = 0.96-1.07) and 1.00 (95% CI = 0.99-1.01) per additional infection for IBD. Adjusting for infections, any versus no antibiotics in the first year was associated with IBD (pooled aHR = 1.33 [95% CI = 1.01-1.76]). The aHR for additional antibiotic course was 1.17 (95% CI = 0.96-1.44), driven by penicillin (per additional course, aHR = 1.28 [95% CI = 1.02-1.60]). Although antibiotics at 1 to < 3 years did not show an association with IBD or Crohn's disease, non-penicillin antibiotics were associated with ulcerative colitis (per additional course, aHR = 1.95 [95% CI = 1.38-2.75]). Conclusion: Early-life antibiotic use was, a significant risk factor for childhood and early adult-onset IBD, independent of infection frequency. |
© Copyright 2013-2025 GI Health Foundation. All rights reserved.
This site is maintained as an educational resource for US healthcare providers only.
Use of this website is governed by the GIHF terms of use and privacy statement.