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Pubmed-Letter: Irritable bowel syndrome and antibiotics-Authors' reply

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Aliment Pharmacol Ther. 2024 Feb;59(3):422. doi: 10.1111/apt.17839.


This article is linked to Staller et al papers. To view these articles, visit https://doi.org/10.1111/apt.17736 and https://doi.org/10.1111/apt.17837

We appreciate the interest by Dr Longstreth1 in our article2 We are not surprised that antibiotic use is higher among those with a diagnosis of irritable bowel syndrome (IBS),3especially since breath test-directed or empiric antibiotic treatment for small intestinal bacterial overgrowth has gained popularity as a treatment for IBS symptoms. We agree that there is a possibility that patients with IBS symptoms would be more likely to get antibiotics for those symptoms than asymptomatic individuals but would counter this by saying those empiric antibiotic courses would often come with a concurrent diagnosis of IBS, justifying the treatment decision.

Nevertheless, we were cognizant of the potential for antibiotics being a marker, rather than a cause, of IBS in our analysis. To account for this possibility, we performed a sensitivity analysis where we varied the window for antibiotic exposure from 0 months (no time elapsed between antibiotic prescription and an IBS diagnosis) up to 24 months (24 months between last antibiotic exposure and an IBS diagnosis). The odds ratio (OR) for IBS did not differ meaningfully with these changes (see Table 4 in the original manuscript). Furthermore, we performed an additional sensitivity analysis where we adjusted for gastrointestinal infection as a cause of antibiotic use up to 1 year prior to the IBS diagnosis date/index date with similar odds of IBS (OR 2.18 [95% confidence interval 2.11–2.25]).

We agree, nonetheless, that there is a complex relationship between disturbances of the gut microbiota and risk of IBS. Further study is needed to determine how antibiotics can both increase risk of developing IBS while also being used as an effective treatment modality.

PMID:38197708 | DOI:10.1111/apt.17839

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