Early Life Antibiotics Linked to Increased Risk of Abdominal Pain

New research shows antibiotic use within the first week of life does result in a risk of developing abdominal pain 4-6 years later.

A team, led by Kim Kamphorst, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, dept. Pediatrics, Amsterdam Gastroenterology, Metabolism & Nutrition, Amsterdam Reproduction & Development Amsterdam, determined whether antibiotics during the first week of life, infantile colic in the first year of life, gut-associated immune markers at 1 year of age, and allergies at 4-6 years of age in term born children is linked to a higher prevalence of functional gastrointestinal disorders at 4-6 years of age.

The Connection

Antibiotic use could lead to the development of various functional gastrointestinal disorders.

In the prospective, observational cohort, the investigators examined 436 term-born infants through age 4-6. Of this group, 151 received broad-spectrum antibiotics and 285 were healthy controls.

In addition, parents of 81% (n = 340) of the available children submitted ROME III and ISAAC questionnaires.

The investigators used independent t-tests, Chi-squared tests, or non-parametric tests and logistic multivariate regression analyses.

Functional Abdominal Pain and Antibiotics

The presence of functional abdominal pain was significantly higher in the antibiotic cohort than it was in the control group (4% vs. 0.4% respectively; P = 0.045) and children with food allergy fulfilled significantly more often the criteria for irritable bowel syndrome (IBS) and abdominal migraine (26% vs. 9%; P = 0.002 and 7% vs. 1%; P = 0.043 respectively) compared to pediatric patients without allergies.

However, there were no differences in functional gastrointestinal disorders at age 4-6 years between participants with or without a history of infantile colic, but there were significant differences found in gut-associated immune markers between pediatric patients with and without functional gastrointestinal disorders.

“Antibiotics during the first week of life resulted in a higher risk for functional abdominal pain at 4–6 years,” the authors wrote. “Furthermore, food allergy was associated with IBS and abdominal migraine at 4–6 years.”

A Multi-Disciplinary Approach to Care

In the past, investigators have sought to implement a multi-care approach to treating functional gastrointestinal disorders, because only a small percentage of patients with functional gastrointestinal disorders generally see an improvement in symptoms after they are provided care by a gastroenterologist. While proven effective, psychological, behavioral, and dietary therapies are not generally provided.

In an open-label, single-center, pragmatic trial, investigators based in Australia examined 144 patients between 18-80 years old with a Rome IV criteria-defined functional gastrointestinal disorder.

The patients were randomly assigned to receive either gastroenterologist-only standard care (n = 46) or multidisciplinary clinic care (n = 98) that included gastroenterologists, dietitians, gut-focused hypnotherapists, psychiatrists, and behavioral physiotherapists.

A total of 26 patients in the standard-care group and 82 in the multidisciplinary-care group saw global symptom improvement (RR, 1,50; 95% CI, 1.13-1.93; P = 0.00045) 29 patients in the standard-care group and 81 patients in the multidisciplinary-care group had adequate relief of symptoms in the past 7 days (P = 0.010).

In addition, patients in the multidisciplinary-care group were more likely to experience a 50% or higher reduction in all Gastrointestinal Symptom Severity Index symptom clusters than the patients who were in the standard-care group.

There was a 50-point or higher reduction for patients with irritable bowel syndrome in the IBS-SSS in 10 of 26 standard-care patients and 13 of 28 patients in the multidisciplinary-care group (P = 0.017).

The study, “Neonatal Antibiotics and Food Allergy are Associated with FGIDs at 4–6 years of age,” was published online in Gastroenterology.