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

Narula N. Wong E.C.L. Pray C. Marshall J.K. Rangarajan S. Islam S. Bahonar A. Alhabib K.F. Kontsevaya A. Ariffin F. Co H.U. Al Sharief W. Szuba A. Wielgosz A. Diaz M.L. Yusuf R. Kruger L. Soman B. Li Y. Wang C. Yin L. Mirrakhimov E. Lanas F. Davletov K. Rosengren A. Lopez-Jaramillo P. Khatib R. Oguz A. Iqbal R. Yeates K. Avezum Á. Reinisch W. Moayyedi P. Yusuf S.
September 2023 W.B. Saunders

Clinical Gastroenterology and Hepatology
2023 #21 Issue 10 2649 - 2659.e16 pp.

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 Crohns 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.

Antibiotics , Crohns Disease , Estrogen , Hormone , IBD , NSAIDS , Oral Contraceptive , Ulcerative Colitis

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Division of Gastroenterology, Department of Medicine, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada
Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud Medical City, King Saud University, Riyadh, Saudi Arabia
National Research Center for Therapy and Preventive Medicine, Russian Federation, Moscow, Russian Federation
Primary Care Medicine, Faculty of Medicine Universiti Teknologi MARA, Selangor, Malaysia
University of the Philippines College of Medicine, Manila, Philippines
Family Medicine Department, Medical Education and Research Department, Dubai Health Authority, Dubai, United Arab Emirates
Department of Angiology, Hypertension and Diabetology, Wroclaw Medical University, Wroclaw, Poland
University of Ottawa Heart Institute, Ottawa, ON, Canada
Estudios Clínicos Latinoamérica Rosario, Santa Fe, Argentina
Independent University, Bashundhara R/A, Dhaka, Bangladesh
Africa Unit for Transdisciplinary Health Research, Potchefstroom, South Africa
Health Action by People, Thiruvananthapuram, Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Kerala, Trivandrum, India
Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
Universidad de La Frontera, Temuco, Chile
Al-Farabi Kazakh National University, Health Research Institute, Almaty, Kazakhstan
Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Västra Götaland Region Region, Sweden
Masira Research Institute, Medical School, Universidad de Santander, Bucaramanga, Colombia
Advocate Aurora Research Institute, Advocate Aurora Health, Downers Grove, IL, United States
Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
Istanbul Medeniyet University, Faculty of Medicine, Department of Internal Medicine, Istanbul, Turkey
Department of Community Health Sciences, Aga Khan University, Sindh, Karachi City, Pakistan
Department of Medicine, Queens University, Kingston, ON, Canada
International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria

Division of Gastroenterology
Population Health Research Institute
Isfahan Cardiovascular Research Center
Department of Cardiac Sciences
National Research Center for Therapy and Preventive Medicine
Primary Care Medicine
University of the Philippines College of Medicine
Family Medicine Department
Department of Angiology
University of Ottawa Heart Institute
Estudios Clínicos Latinoamérica Rosario
Independent University
Africa Unit for Transdisciplinary Health Research
Health Action by People
Medical Research and Biometrics Center
Kyrgyz State Medical Academy
Universidad de La Frontera
Al-Farabi Kazakh National University
Sahlgrenska Academy
Masira Research Institute
Advocate Aurora Research Institute
Institute of Community and Public Health
Istanbul Medeniyet University
Department of Community Health Sciences
Department of Medicine
International Research Center
Division of Gastroenterology and Hepatology

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