Letter: The Hidden Truth of IBD Risk—From Antibiotics to Environmental Factors

Abstract

Editors,

Inflammatory bowel disease (IBD) has shown a significant rise in global incidence over the past few decades, with particularly rapid increase in children and adolescents [1, 2]. Early-life antibiotic use has profound effects on the gut microbiome and immune system, linking it to an elevated risk of IBD [1, 3]. Despite growing research, the specific impacts of different antibiotic types, doses and timing on IBD risk remain unclear. Furthermore, the interplay between environmental factors and the gut microbiota requires further investigation. Bridging these knowledge gaps is crucial for alleviating the growing burden of IBD among children and adolescents.

We commend Dr. Mårild et al. [4] for their work in investigating the relationship between early-life infections, antibiotic use and the risk of IBD in children and adolescents. They demonstrated that early-life antibiotic use, particularly of penicillin, was significantly associated with an increased risk of IBD (adjusted hazard ratio: 1.33), while infection frequency at ages 0–1 and 1–3 years showed no significant association. This provides critical evidence for understanding the long-term effects of antibiotics on the gut microbiome and immune system. However, some limitations in the study warrant further exploration.

First, the study relied solely on usage frequency without analysing antibiotic dosage and duration, which limits the understanding of their impact on gut microbiome disruption. Second, environmental factors such as sanitation, dietary patterns and air pollution were not included, despite their potential relevance to IBD through their effects on the gut microbiome and immune system [5, 6]. Lastly, the study did not explicitly exclude children with underlying health conditions, potentially confounding the causal relationship between antibiotic use and IBD risk [7, 8].

To address these limitations, future studies should include analyses of antibiotic dosage and duration to evaluate their effects on the gut microbiome and IBD risk. Additionally, environmental factors should be integrated into study models to quantify their interactions with antibiotic use and IBD development. Rigorous screening of children with underlying health conditions is essential, with subgroup analyses or multivariable adjustments used to control for potential confounders. Multi-omics approaches might be employed to dynamically analyse the impact of antibiotics on the microbiome and immune system, uncovering causal links between microbial imbalance and IBD onset.

Xueneng Yang: writing – original draft, writing – review and editing, conceptualization. Ruijuan Li: writing – original draft, writing – review and editing, conceptualization.

The authors have nothing to report.

The authors declare no conflicts of interest.

This article is linked to Mårild et al paper. To view this article, visit https://doi.org/10.1111/apt.18358.