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Clin Gastroenterol Hepatol DOI:10.1016/j.cgh.2020.05.036

Antibiotic Use Associated With Risk of Colorectal Polyps in a Nationwide Study.

Publication TypeJournal Article
Year of Publication2020
AuthorsSong, M, Nguyen, LH, Emilsson, L, Chan, AT, Ludvigsson, JF
JournalClin Gastroenterol Hepatol
Date Published2020 May 23

BACKGROUND & AIMS: Use of antibiotics affects the composition of the microbiome and might affect development of colorectal polyps, which are precursors to colorectal cancer.

METHODS: We performed a nested case-control study in Sweden of 45,744 patients with a colorectal polyp (cases) in the nationwide gastrointestinal ESPRESSO histopathology cohort, using unaffected full siblings as controls (n=93,307). Polyps were classified by morphology SnoMed codes into conventional adenomas and serrated polyps. Through linkage to the Prescribed Drug Register, we assessed use and cumulative dispensations of antibiotic until one year prior to polyp diagnosis for cases and their sibling controls.

RESULTS: During a median study period of 6.9 years, compared with non-users, users of antibiotics (28,884 cases [63.1%] and 53,222 sibling controls [57.0%]) had a higher risk of colorectal polyps. Risk increased with higher number of dispensations (odds ratio [OR] for ≥ 6 dispensations, 1.33; 95% CI, 1.25-1.43) (P<.0001 we="" observed="" a="" stronger="" association="" with="" polyps="" for="" broad-spectrum="" antibiotics="" ratio="" ci="" than="" narrow-spectrum="" and="" tetracyclines="" quinolones="" penicillin="" other="" classes="" ranged="" from="" to="" the="" findings="" remained="" robust="" several="" sensitivity="" analyses="" including="" use="" of="" lead-in="" period="" antibiotic="" assessment="" correction="" misclassification="" in="" controls.="" was="" more="" strongly="" associated="" risk="" serrated="" compared="" conventional="" adenomas="" found="" no="" differences="" colon="" vs="" rectal="">0.10). We found stronger associations for younger (

CONCLUSIONS: In a nationwide case-control study in Sweden, after accounting for hereditary and early life environmental factors, antibiotic use was associated with increased risk of colorectal polyps. Our findings indicate a role for intestinal dysbiosis in early stages of colorectal carcinogenesis.


Alternate JournalClin. Gastroenterol. Hepatol.
PubMed ID32454258