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Long-Term Use of Antibiotics Associated with Later-Life Colorectal Adenomas

Dolphin

Senior Member
Messages
17,567
http://www.jwatch.org/fw112737/2017...later-life?query=pfw&jwd=000020001524&jspc=US

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http://gut.bmj.com/content/early/2017/03/16/gutjnl-2016-313413

Long-term use of antibiotics and risk of colorectal adenoma
FREE

  1. Yin Cao1,2,3,
  2. Kana Wu3,
  3. Raaj Mehta1,2,
  4. David A Drew1,2,
  5. Mingyang Song1,2,3,
  6. Paul Lochhead1,2,
  7. Long H Nguyen1,2,
  8. Jacques Izard4,
  9. Charles S Fuchs5,6,7,
  10. Wendy S Garrett8,9,10,
  11. Curtis Huttenhower9,11,
  12. Shuji Ogino8,12,13,
  13. Edward L Giovannucci3,12,14,
  14. Andrew T Chan1,2,9,14
Author affiliations

Abstract
Objective Recent evidence suggests that antibiotic use, which alters the gut microbiome, is associated with an increased risk of colorectal cancer. However, the association between antibiotic use and risk of colorectal adenoma, the precursor for the majority of colorectal cancers, has not been investigated.

Design We prospectively evaluated the association between antibiotic use at age 20–39 and 40–59 (assessed in 2004) and recent antibiotic use (assessed in 2008) with risk of subsequent colorectal adenoma among 16 642 women aged ≥60 enrolled in the Nurses' Health Study who underwent at least one colonoscopy through 2010. We used multivariate logistic regression to calculate ORs and 95% CIs.

Results We documented 1195 cases of adenoma. Increasing duration of antibiotic use at age 20–39 (ptrend=0.002) and 40–59 (ptrend=0.001) was significantly associated with an increased risk of colorectal adenoma. Compared with non-users, women who used antibiotics for ≥2 months between age 20 and 39 had a multivariable OR of 1.36 (95% CI 1.03 to 1.79). Women who used ≥2 months of antibiotics between age 40 and 59 had a multivariable OR of 1.69 (95% CI 1.24 to 2.31). The associations were similar for low-risk versus high-risk adenomas (size ≥1 cm, or with tubulovillous/villous histology, or ≥3 detected lesions), but appeared modestly stronger for proximal compared with distal adenomas. In contrast, recent antibiotic use within the past four years was not associated with risk of adenoma (ptrend=0.44).

Conclusions Long-term antibiotic use in early-to-middle adulthood was associated with increased risk of colorectal adenoma.
 

Jenny

Senior Member
Messages
1,388
Location
Dorset

Daffodil

Senior Member
Messages
5,875
oh no. I have been on antibiotics for years. maybe I should get colonoscopy.

@Jenny did you have symptoms of adenomas? how did you know they were there??

did you take probiotics with the antibiotics?
 

Jenny

Senior Member
Messages
1,388
Location
Dorset
oh no. I have been on antibiotics for years. maybe I should get colonoscopy.

@Jenny did you have symptoms of adenomas? how did you know they were there??

did you take probiotics with the antibiotics?

Yes I had some bleeding with the first one and that was why I had the colonoscopy. That was the large one. I was told to have another colonoscopy in 3 years and so had that a couple of months ago and they found another smaller adenoma. I hadn't had any symptoms with that one.

And yes I did take probiotics - can't remember which though.
 

Daffodil

Senior Member
Messages
5,875
Yes I had some bleeding with the first one and that was why I had the colonoscopy. That was the large one. I was told to have another colonoscopy in 3 years and so had that a couple of months ago and they found another smaller adenoma. I hadn't had any symptoms with that one.

And yes I did take probiotics - can't remember which though.
oh no. may I ask what kind of bleeding you had? was it on the poop (sorry) or just the toilet paper when you wiped?
 

Daffodil

Senior Member
Messages
5,875
Just on the toilet paper - it was very little, and would come and go.
oh dear. i have had that for decades. i had a colonoscopy once in my life, over 10 yrs ago. i was always under the impression that the time to worry is when blood is on the poop....but tiny amounts would not be noticed there anyway

i am so glad you posted this @Dolphin and @Jenny

i am so critical of poeple now who ignore their health and i have done it myself by not having colonoscopies ugh
xo
 

Jenny

Senior Member
Messages
1,388
Location
Dorset
oh dear. i have had that for decades. i had a colonoscopy once in my life, over 10 yrs ago. i was always under the impression that the time to worry is when blood is on the poop....but tiny amounts would not be noticed there anyway

i am so glad you posted this @Dolphin and @Jenny

i am so critical of poeple now who ignore their health and i have done it myself by not having colonoscopies ugh
xo
oh dear. i have had that for decades. i had a colonoscopy once in my life, over 10 yrs ago. i was always under the impression that the time to worry is when blood is on the poop....but tiny amounts would not be noticed there anyway

i am so glad you posted this @Dolphin and @Jenny

i am so critical of poeple now who ignore their health and i have done it myself by not having colonoscopies ugh
xo

Do see a doctor about this Daffodil. I didn't find the colonoscopies to be painful or even uncomfortable, especially with a sedative. The prep is the worst thing.
 

duncan

Senior Member
Messages
2,240
This is a concerning study, and it certainly strikes a cord for anyone who has had a suspected or confirmed disease that drew protracted abx therapy. (It may prove popular in the abx stewardship lobby, though.)

Incidentally, I had over 15 polyps removed during my last colonoscopy, and that was before I ever embarked on a lengthy abx therapy for suspected TBDs.. I wonder if it is, in part, the way some of our bodies may react to chronicity rather than the abx, but that seems kind of a stretch unless the condition is cross-elastic across a spectrum of diseases. Regardless, I am certainly taking these findings to heart, and will bring them up with my infectious disease specialist when next I see him.
 

Hip

Senior Member
Messages
17,852
It is a pity this study did not also examine the relative risk of developing colorectal adenoma, the precursor for the majority of colorectal cancers, in patients given long term antibiotics, but then who afterwards and/or during this course of antibiotics, took probiotics in order to repopulate their gut with friendly bacteria.

The probiotics may well have negated the increased risk of developing colorectal adenoma from long term antibiotic use. It's even conceivable that people taking antibiotics + probiotics might result in a lower risk for colorectal adenoma (ie, antibiotics killing off bad bacteria, and the probiotics then replacing them with good bacteria).

This paper examines some of the possible mechanisms by which probiotics (and the prebiotic foods which feed them) may prevent colorectal cancer.

The paper says the possible beneficial anti-colorectal effects of probiotics include:
  • Alteration of the intestinal microflora
  • Inactivation of cancerogenic compounds
  • Competition with putrefactive and pathogenic microbiota
  • Improvement of the host’s immune response
  • Anti-proliferative effects via regulation of apoptosis and cell differentiation
  • Fermentation of undigested food
  • Inhibition of tyrosine kinase signaling pathways

I have always made of point of taking probiotics for at least week after any antibiotics I take.



On the subject of prebiotics:

This paper mentions that the number of colon polyps appearing in rats feed a high-beef diet was reduced when rye bran was added to the high beef diet, but there was almost no reduction of polyps at all when inulin was added to the high beef diet (inulin is a prebiotic found in fruit and vegetables, and sold as a prebiotic supplement).

Though they point out that there have been a number of contradictory studies on the protective effects of prebiotics on colon cancer.
 

TigerLilea

Senior Member
Messages
1,147
Location
Vancouver, British Columbia
oh dear. i have had that for decades. i had a colonoscopy once in my life, over 10 yrs ago. i was always under the impression that the time to worry is when blood is on the poop....but tiny amounts would not be noticed there anyway

i am so glad you posted this @Dolphin and @Jenny

i am so critical of poeple now who ignore their health and i have done it myself by not having colonoscopies ugh
xo
You want to catch adenomas/polyps long before they start bleeding. If you notice changes in your bowel habits for longer than two weeks it should be checked out. Also if your poops become long and skinny that is a sign that there is an obstruction.