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TOPLINE:

Prior use of antibiotics was modestly more common among individuals with biopsy‑confirmed celiac disease (CD) than among matched comparators from the general population and unaffected siblings. However, an even more prominent use of antibiotics among individuals with normal small intestinal mucosa likely reflected increased medical surveillance for gastrointestinal symptoms rather than a causal effect of antibiotics on CD.

METHODOLOGY:

• CD is an immune-mediated enteropathy triggered by gluten in genetically predisposed individuals. Although the use of antibiotics has been linked to CD, prior studies have not assessed whether this reflects surveillance bias among patients receiving antibiotics.
• Using data from nationwide Swedish healthcare registers, researchers conducted a case-control and sibling analysis between 2007 and 2023 and analyzed 27,789 individuals with biopsy-confirmed CD (median age at diagnosis, 28 years; 62.6% women) who were matched to 133,451 comparators from the general population and 33,112 siblings without CD.
• Antibiotic exposure was defined as filling any systemic antibiotic prescription at least 1 year before the diagnosis of CD or the matched date for control individuals.
• To assess surveillance bias, a secondary analysis of 225,548 individuals with histologically normal small intestinal mucosa (median age at the time of biopsy, 41 years; 60.8% women) was conducted, who were matched to 1,089,796 comparators from the general population.

TAKEAWAY:

• Prior use of antibiotics was more common in individuals with CD than in matched comparators up to 1 year before the diagnosis of CD (69% vs 63%; adjusted odds ratio [aOR], 1.24; 95% CI, 1.21-1.28); the association became stronger with cumulative antibiotic dispensations (one to two dispensations: aOR, 1.21; 95% CI, 1.17-1.25; three or more dispensations: aOR, 1.35; 95% CI, 1.30-1.41; P for trend < .001).
• Similarly, in the sibling analysis, prior use of antibiotics was more common among individuals with CD vs their unaffected siblings (70.0% vs 63.8%; aOR, 1.29; 95% CI, 1.24-1.35), with increasing ORs for CD with cumulative use (one to two dispensations: aOR, 1.28; 95% CI, 1.22-1.34; three or more dispensations: aOR, 1.35; 95% CI, 1.27-1.44 vs none; P for trend < .001).
• The use of antibiotics was higher among individuals with histologically normal mucosa than among matched comparators (72.9% vs 63.8%), yielding an aOR of 1.50 (95% CI, 1.48-1.51), with the association being stronger for three or more earlier dispensations (aOR, 1.80; 95% CI, 1.78-1.83; P for trend < .001).
• Compared with people with normal biopsies, those with biopsy‑confirmed CD had 17% lower odds of prior antibiotic use (aOR, 0.83; 95% CI, 0.81-0.86), suggesting that antibiotics were more common among those investigated but without CD.

IN PRACTICE:

“Although antibiotic stewardship has clear benefits, a causal link between antibiotic use and CD has not been established, and CD concerns should not deter appropriate antibiotic use,” the authors of the study wrote.

SOURCE:

This study was led by Maria Ulnes, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden. It was published online in Clinical Gastroenterology and Hepatology.

LIMITATIONS:

The study could not fully exclude reverse causation and residual confounding. The analysis was restricted to biopsy-confirmed CD, potentially capturing individuals with more advanced or symptomatic disease. The absence of nationwide serology data meant that the extent to which individuals with normal mucosa had undergone serologic testing for CD before biopsy remained unknown.

DISCLOSURES:

This study received support from grants provided by the Swedish state under the agreement between the Swedish government and county councils and other sources. One author disclosed receiving financial support from a healthcare company for a study on inflammatory bowel disease and fibrosis and for developing a paper reviewing national healthcare registers in China and having an ongoing research collaboration on CD with a pharmaceutical company.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.