17 ms·

Childhood antibiotics as a risk factor for Crohn's disease: Cohort study

211 points by Jimmc414 4y ago

w10-1 4y ago
OMG, does anyone think that with samples size this small that this study means anything? The effect is barely significant, and the potential confounders could fill a dictionary. Crohn's et al is important, but this study adds little more than noise.
- nerdponx 4y ago
  Barely significant how? And that sample size is pretty good considering the low incidence of Crohn's in general and the fact that study participants had to be sought out and recruited.
sammyjoe72 4y ago
I had chronic tonsillitis as a kid. The doctors treated it with antibiotics until finally after about 3 years they recommended I just get my tonsils out. I got diagnosed with UC about 14 years ago. Also have had psoriasis for years. I blame both on excessive use of antibiotics as a 5 - 8 yr old.
- steve_adams_86 4y ago
  Hey, me too. Kind of bummed that had to happen. I had a few invasive and unnecessary operations as a kid. I walked on my tippy toes for example, and lost flexibility in my ankles. Rather than, you know, stretch and exercise my ankles… My Achilles’ tendons were cut and stretched, then I was in casts with my ankles extended for quite a while. Nothing was really physically wrong, I was just a weird kid. Western medicine is both miraculous and barbaric
  - John23832 4y ago
    Thats… kind of crazy. My brother toe walks and they just let him walk.
- a9h74j 4y ago
  Since you specifically mention one cure through removal, my data point on Crohns and surgery: Took years for me to finally get a clue about surgery for Crohns in a case as unremittant as mine. My guess at the time was that MDs consider referral to surgery as "medical failure" -- I've seen that term in the literature -- so do not volunteer the option. Anecdata: Root canal, antibiotics, and first Crohns indications in the span of 10 days for me.
  - danachow 4y ago
    > "medical failure" Medical failure in the literature is a jargon term. (Internal) medicine and surgery are traditionally two distinct fields of, er, medicine. So it is just a matter of fact that a disease such as Crohn's that is refractory or resistant to treatment with medicine is a "medical failure" - no spin on it, that's what we call it. Biases in referral across services is a complicated topic, and there is quite a bit of literature about it over the years. I am not sure about Crohn's/IBD specifically, but it's one of the well known co-management touch-points between surgery and GI, so there might be something written on the subject. There are many complexities at play here, some is definitely due to human factors, but the simple thought of "medical failure" doesn't have much to do with it. The average internists make thousands of consults to surgery every year, so that's really not it, there's much more to it.
    - a9h74j 4y ago
      Thanks, very helpful. That is one less questionable inference I will carry around. Speaking of complexities, I'm fairly sure the GI who did not refer me was married -- so he told me I'm 98% sure -- to a pharmaceutical salesperson who sold GI related infusions (and he got me in a perhaps unrelated study). There were other manner-related problems. .. Does not change my profound regard for MDs in general. (Have worked with MD/PhDs, wouldn't be alive without some interventions, very dedicated care, etc.) Be well.
- hndude 4y ago
  You may be interested in the book The Keystone Approach by Rebecca Fett. It goes over research into the connection between pediatric strep throat and psoriasis. IIRC(from the book), if you are diagnosed with psoriasis before the age of 40, there is a 90% chance that it happened shortly after a... bad case of strep throat? Tonsillectomy? I forget which. Pretty eye opening book with some good diet-based advice on reducing symptoms of psoriasis, if you are looking for relief.
Mildlypolite 4y ago
Two words : fecal transplant.
- hndude 4y ago
  Has that helped your crohns? Or other stomach or autoimmune issues?
deleted 4y ago
[deleted]
sgammon 4y ago
this is fascinating, thank you for sharing
ghostly_s 4y ago
I’m not familiar with the 'Odds Ratio,' but after reading the Wikipedia page, it seems the number here represents a very weak correlation. Am I mistaken?
- deleted 4y ago
  [deleted]
- nerdponx 4y ago
  There are some other issues with this study that might strain credibility, but yes, I think you are mistaken about the size of the effect being reported. At low prevalence probabilities, odd ratios are more or less just multipliers on the prevalence probability. So if there is a 0.1% probability of developing Crohn's without childhood antibiotics, an odds ratio of 3.5 would mean that there is approximately an 0.35% probability of developing Crohn's with childhood antibiotics. That's 100 in 100k vs. 350 in 100k, and in my opinion that's not a small difference. More generally, an odds ratio is the ratio of the odds of something under two different sets of circumstances.
drewg123 4y ago
I have Crohn's and I remember my pediatrician as being very willing to prescribe meds at the drop of a hat. I still remember the oral antibiotics I had as a little kid in the 70s. So this would not surprise me. A lot of the theories I've heard of Crohn's is it happens because modern humans are too clean, germ free and not riddled with parasites, giving the immune system too much free time at which point it starts attacking the gut.
- atwood22 4y ago
  Another piece of supporting evidence: https://www.medicalnewstoday.com/articles/growing-up-with-a-dog-might-protect-against-crohns-disease#:~:text=Researchers%20observed%20that%20individuals%20who,the%20risk%20of%20Crohn's%20disease https://www.medicalnewstoday.com/articles/growing-up-with-a-.... Those that grow up with dogs may be less likely to develop Crohn's. Dogs have been shown to increase the strength of a child's immune system.
hunter-gatherer 4y ago
I'm glad this just came up. My ten-year old nephew has been in and out of hospital stays for the past 4 years and was just finally diagnosed with Crohn's and released from a long stay at the hospital this week. They've now got him on a diet that they claim seems to help a bit but I haven't seen it. As a result of having undiagnosed Crohn's for some years he has fallen behind in school, with friends, and so on. If anybody is aware of any support groups, diets, good doctors, or any advice in general for young kids with Crohn's, please post. I may not have time to respond but I'll definitely read through responses. If an email is more appropriate you can send one to qbwkmaz@protonmail.com. Thanks in advance.
- timonovici 4y ago
  In my case, medicine and diet had little effect. And I was in pretty bad shape, i got to the emergency room several times a week with awful abdominal pain, vomiting, constipation. A different doctor adviced me to eat anything I want, but for at least half a year to eat kefir with every meal. That worked. Whenever I feel like my digestive tract is getting funny, i add a few bottles of kefir for a few days.
  - deleted 4y ago
    [deleted]
  - danachow 4y ago
    You have actual Crohn's or IBS? Because your symptoms while distressing don't sound like Crohn's at all. Crohn's is an autoimmune inflammatory condition with actual tissue destruction. People with Crohn's flares don't show up to the ED with constipation, they often show up with profusely bloody diarrhea. Additionally weight loss and anemia. They may likely require admission for high dose steroids. People with Crohn's will often need surgery. What you're describing sounds more like IBS. A bottle of kefir is unlikely to hurt. However, I am quite skeptical that such a thing has any prophylactic effect once a recurrent process like Crohn's is set in motion - like pissing on a gasoline fire. A bottle of kefir is not going to touch an actual Crohn's flare at all. There's no good evidence that any specific diets seem to help the chronic course of Crohn's unfortunately, and it's not like no one has looked.
AugustusCrunch 4y ago
I have a child who had Crohns. This has been known since antibiotics were invented. All IBS conditions are caused by the wrong gut bacteria - typically c. diff - and the cure rate for fecal bacteriotherapy is about 95% in one shot. It's ludicrous that we're still studying this and acting as though it's such a mystery, while people suffer and die.
- danachow 4y ago
  You are confusing Crohn's, an inflammatory bowel condition that is life long and can often be disfiguring and requiring surgery with IBS which is completely unrelated, non-inflammatory (if it were then it would not be IBS), with distressing but not usually life limiting sequelae. Do you even know what IBS stands for? The fact is we do not understand the complete mechanisms of either Crohn's or IBS, but based on their presentation and treatment it is unlikely they are too closely related - and it is likely that IBS is itself due to multiple factors - hence it is a syndrome, not a disease. Given this, it is hogwash to say all of any kind of condition is caused by one thing. And if there was a cure with 95% effectiveness, I am sure many of the affluent IBS sufferers on this site would have figured it out by now. > and the cure rate for fecal bacteriotherapy is about 95% in one shot. It's ludicrous that we're still studying this and acting as though it's such a mystery. This is crackpottery.
rossdavidh 4y ago
On the one hand, it makes total sense to me that childhood antibiotics could mess up your digestive tract immune system. On the other hand: "Subgroup analysis showed that antibiotic use <18 years old was a risk factor for CD development in the Chinese (adjusted OR 4.80, 95% CI 1.62–12.24; P = 0.005) but not in Australian populations (OR 1.80, 95% CI 0.33–9.95; P = 0.498)." If it were a robust finding, it would not fall apart on subgroup analysis.
- admiralpumpkin 4y ago
  Actually the reverse, we should be skeptical of subgroup analyses, because they are often fishing for results, have issues with multiple comparisons, and are typically underpowered.
  - deleted 4y ago
    [deleted]
- xxpor 4y ago
  Different antibiotics/doses/frequency of prescription in different countries? Haven't read the whole thing yet though.
  - cpncrunch 4y ago
    Just look at the results table. Even for china it looks like only certain age ranges show the effect. Most likely just random.
popotamonga 4y ago
Happened to me. My doctor as a kid would just prescribed antibiotic for everything thing,no matter what. How can there be such bad doctors.
- timonovici 4y ago
  Yeah, i remember being prescribed ampicillin and aspirin for every cold, as a child. They didn't care, they only wanted to "do something". I remember in highschool having a colleague who's overprotective mother was also a germophobe, and was treating her only son with ever increasing doses of antibiotics every winter. By the time we met, pills had no effect(according to them, the hell knows what they meant by "effectiveness"), and he was getting intramuscular ones. The poor people probably never learned that there almost no antivirals, and are doing more harm that good. Antibiotics are thought to be a panacea around here, in eastern Europe.
- dham 4y ago
  They still do. It's literally insane. Most will prescribe oral for everything even if it's just a cut. Not only will they give antibiotics they won't even tell someone to take a probiotic during treatment. Most doctors I've met over the years just phone it in and don't stay up to date on anything.
  - kube-system 4y ago
    It’s partially doctors giving in to the demands of patients who want a prescription for everything. I think it’s a side effect of our expensive healthcare system. People don’t like paying their copay for just a band aid. Or to be told “it’s a virus, get some sleep and drink fluids”. They want to feel like they got something for their money.
    - mirekrusin 4y ago
      That's why we now have homeopathy placebos in pharmacies.
- swayvil 4y ago
codeTired 4y ago
The healthcare needs to be completely overhauled. So many doctors are completely ignorant of risks of antibiotics and other meds. There was a study that found 7% of doctors reported adverse reactions. Some were scared, some didn’t know how, some didn’t have time. Some doctors made no reports in nearly lifetime of practice. When I was 16-22 I had multiple 6+ months courses of doxycycline for acne. I have seen multiple dermatologist who said nothing can be done about my cystic acne. At some point I was tired of doxy making me feel awful so I researched different skin types and skin care routines. As long as I use a mild soap twice a day, use a moisturizer and don’t touch my skin I get 0 cystic acne but it took weeks to see the results. No doctor ever told me about different types of skin and I was young and dumb. My parents didn’t know any better. And internet wasn’t as popular back then. Then, I got an adverse reaction to cipro. And 40+ doctors ignored it. Told me it’s all in my head. Told me to seek help for my mental health and depression. Later FDA added warning about permanent nerve damage. I still have to send studies to doctors because they try to tell me I’m wrong, after I had every test under the sun to rule out other causes. I help admin flouroquinolone toxicity group and every day we get individuals who were given these last resort meds for suspected infection. It is border line medical malpractice. However, I have seen that it is impossible to find a lawyer to take the case and find a physician willing to testify. There needs to be a better system for tracking allergic reactions and trends. For example, cipro might show no reaction up to 6 months. Then, you snap your Achilles. The doctor won’t tell you it was cipro unless you tell him. It’s fucked and extremely underreported.
- victorclf 4y ago
  I research every prescribed treatment side effects after levofloxacin gave me bilateral achilles tendinitis. In my experience, potential side effects and complications from treatments are never discussed with patients. I also had the displeasure of suffering from the mental side effects of the antiallergic montelukast, which again were not even mentioned by the doctor despite the serious FDA warning.
- ReptileMan 4y ago
  >The healthcare needs to be completely overhauled. So many doctors are completely ignorant of risks of antibiotics and other meds. Doctors are well aware by my talks with them. There is unfortunately a large subset of the population that unless prescribed antibiotics feel that they have not been taken care by the doctor. So there is quite a demand.
Saint_Genet 4y ago
I suspect (but have no science to back it up) that it’s a risk factor for many things. I had ear infections more or less constantly in my childhood and were on antibiotics the whole time until they finally stooped working. The end result is that I’m now deaf on one ear. I get why they were prescribed, it stopped the acute pain but no one thought about the long term
PaulKeeble 4y ago
Antibiotics are actually really more damaging than we realise. Western digestive tracts show significant differences in microbiome that those of people who do not use antibiotics as treatment and some of the lost species are really important. We also have no way to fix it currently, some of the species like Faecalibacterium Prausnitzii are critical to our bodies energy system but can't survive in oxygen, so we have no way to eat it at all, you kill it then its gone likely for good. Others like Limosilactobacillus reuteri stop fungus from inhabiting our small intestine as well as other bacteria but just 5% of us still have some of it as its very susceptible to antibiotics. We don't know what ideal microbiomes look like, we just know the bulk of people living in the western world have unhealthy ones that are missing key species and we have only scratched the surface of understanding.
- deleted 4y ago
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- bobbylarrybobby 4y ago
  How are bacteria that can't be eaten first acquired by infants?
  - PaulKeeble 4y ago
    Passed to them from their mother while in the womb. Seems to be transferred at birth but there is some evidence it happens earlier too.
    - refurb 4y ago
      Source? Amniotic fluid and blood is sterile. Newborns acquire their biome once born by ingesting various food and contact from family members.
      - steve_adams_86 4y ago
        People imagine some special mechanism of transfer, but the reality is that we get bacteria from inside and outside of our bodies all over stuff, all the time, and we’re crawling with it. The babies would be introduced to GI tract flora pretty much immediately even if you tried to prevent it (unless you prevent it with antibiotics of course).
jamal-kumar 4y ago
I had really bad IBS from consuming water on a tropical island in Panama one time and suffered for a few years with even my doctor friend telling me "Damn that sucks, not much you can do except manage". Pretty horrible symptoms until I discovered L. Reuteri. [1] I read that it's been a bacteria that was more commonly found in samples until around the 1950s when people started consuming more garbage processed food and was sold. Simply stated, it changed my life. It emits a substance called Reuterin which inhibits the growth of other more harmful bacterial species. [2] I can't speak personally for suffering on the level of Crohn's disease, but there's positive research out there regarding it. [3] [4] [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5917019/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5917019/ [2] https://en.wikipedia.org/wiki/Reuterin https://en.wikipedia.org/wiki/Reuterin [3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7270012/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7270012/ [4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468961/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468961/
- ng12 4y ago
  > Damn that sucks, not much you can do except manage This has been my entire experience with gastroenterology as a field. Once they rule out cancer there's really not much they can do for you. Meanwhile, I'm waiting for the revolution in our understanding of the microbiome.
  - kevinmchugh 4y ago
    I couldn't swallow pills before, my gastroenterologist performed surgery which corrected that. She also proscribed pills which address my GERD
    - ng12 4y ago
      That's fair. Guess I'm mostly talking about the other end of the system :)
      - danachow 4y ago
        There are actually biologic treatments for Crohn's/UC, not everyone responds but they produce remission which can spare or prolong time to surgery for many.
saiya-jin 4y ago
Wife is a internal doctor (Switzerland's biggest hospital), and we were very wary about avoiding giving any kind of antibiotics before our kids reached age of 1. Common knowledge among peer doctors is that even single usage before 12 months significantly increases risk of diabetes later in life significantly (and god knows what other nasty side effects). In some cases they are miracle cure, with some nasty side effects. But general over-prescription even in relatively developed world is ridiculous. From my less developed and highly corrupt home (Slovakia/Czech republic), I often get news from friends who got prescribed full course of antibiotics on clearly viral infections. General doctors there are mostly on such an abysmal level that self-treatment is sometimes better than their clueless visits. Even for small kids. Another item are painkillers - I see prescriptions for literally anything, usually heavy doses of paracetamol or ibuprofen but I've seen worse for maladies which don't warrant it. I don't even take those in pharmacies unless I know I have acute inflammation to treat.
- Daniel_sk 4y ago
  My wife is a GP in Slovakia and she has a device for a quick test (CRP) whether you have a bacterial infection in blood or not. So they don’t prescribe antibiotics if the test is negative. And she doesn’t recommend them if not necessary - unfortunately many patients demand them because that’s what they expect to get. But she is maybe an exemption who cares a lot about each patient and invests into better equipment even though you are not really incentivized by the system to do so.
refurb 4y ago
Well when your kid is screaming in pain from an ear infection, I'm not sure I'm going to decline to treat them with antibiotics because of some small future risk of Crohn's disease.
- weberer 4y ago
  Maybe just give them topical antibiotics?
  - refurb 4y ago
    Topical antibiotics won't penetrate the inner ear. You can use drops for outer ear infections, but if it's on the other side of the ear drum, it needs to be oral antibiotics.
    - ls15 4y ago
      The other side of the ear drum is directly connected to the respiratory system though. It may not be good advice and children probably would hate it, but I am pretty sure that sniffing small drops of hydrogen peroxide solution helped with my ear infections.
      - refurb 4y ago
        Typically if a child has a middle ear infection, the eustachian tube is blocked. Otherwise the pressure from the infection would just drain through the back of the nose.
  - ls15 4y ago
    Or even disinfectants instead of antibiotics. I've been using a few drops of hydrogen peroxide for ear infections forever and it always took care of them. Why would I want to disturb my entire microbiome for a small local infection?
- nsgi 4y ago
  Does the study recommend antibiotics not be used to treat ear infections? I would think the message is that it's even more important not to use antibiotics when they're not needed, not that they shouldn't be used at all
sk8terboi 4y ago

211 points by Jimmc414 4y ago

OMG, does anyone think that with samples size this small that this study means anything? The effect is barely significant, and the potential confounders could fill a dictionary. Crohn's et al is important, but this study adds little more than noise.

nerdponx 4y ago
Barely significant how? And that sample size is pretty good considering the low incidence of Crohn's in general and the fact that study participants had to be sought out and recruited.

sammyjoe72 4y ago

I had chronic tonsillitis as a kid. The doctors treated it with antibiotics until finally after about 3 years they recommended I just get my tonsils out. I got diagnosed with UC about 14 years ago. Also have had psoriasis for years. I blame both on excessive use of antibiotics as a 5 - 8 yr old.

steve_adams_86 4y ago
Hey, me too. Kind of bummed that had to happen. I had a few invasive and unnecessary operations as a kid. I walked on my tippy toes for example, and lost flexibility in my ankles. Rather than, you know, stretch and exercise my ankles… My Achilles’ tendons were cut and stretched, then I was in casts with my ankles extended for quite a while. Nothing was really physically wrong, I was just a weird kid. Western medicine is both miraculous and barbaric
- John23832 4y ago
  Thats… kind of crazy. My brother toe walks and they just let him walk.
a9h74j 4y ago
Since you specifically mention one cure through removal, my data point on Crohns and surgery: Took years for me to finally get a clue about surgery for Crohns in a case as unremittant as mine. My guess at the time was that MDs consider referral to surgery as "medical failure" -- I've seen that term in the literature -- so do not volunteer the option. Anecdata: Root canal, antibiotics, and first Crohns indications in the span of 10 days for me.
- danachow 4y ago
  > "medical failure" Medical failure in the literature is a jargon term. (Internal) medicine and surgery are traditionally two distinct fields of, er, medicine. So it is just a matter of fact that a disease such as Crohn's that is refractory or resistant to treatment with medicine is a "medical failure" - no spin on it, that's what we call it. Biases in referral across services is a complicated topic, and there is quite a bit of literature about it over the years. I am not sure about Crohn's/IBD specifically, but it's one of the well known co-management touch-points between surgery and GI, so there might be something written on the subject. There are many complexities at play here, some is definitely due to human factors, but the simple thought of "medical failure" doesn't have much to do with it. The average internists make thousands of consults to surgery every year, so that's really not it, there's much more to it.
  - a9h74j 4y ago
    Thanks, very helpful. That is one less questionable inference I will carry around. Speaking of complexities, I'm fairly sure the GI who did not refer me was married -- so he told me I'm 98% sure -- to a pharmaceutical salesperson who sold GI related infusions (and he got me in a perhaps unrelated study). There were other manner-related problems. .. Does not change my profound regard for MDs in general. (Have worked with MD/PhDs, wouldn't be alive without some interventions, very dedicated care, etc.) Be well.
hndude 4y ago
You may be interested in the book The Keystone Approach by Rebecca Fett. It goes over research into the connection between pediatric strep throat and psoriasis. IIRC(from the book), if you are diagnosed with psoriasis before the age of 40, there is a 90% chance that it happened shortly after a... bad case of strep throat? Tonsillectomy? I forget which. Pretty eye opening book with some good diet-based advice on reducing symptoms of psoriasis, if you are looking for relief.

Mildlypolite 4y ago

Two words : fecal transplant.

hndude 4y ago
Has that helped your crohns? Or other stomach or autoimmune issues?

deleted 4y ago

[deleted]

sgammon 4y ago

this is fascinating, thank you for sharing

ghostly_s 4y ago

I’m not familiar with the 'Odds Ratio,' but after reading the Wikipedia page, it seems the number here represents a very weak correlation. Am I mistaken?

deleted 4y ago
[deleted]
nerdponx 4y ago
There are some other issues with this study that might strain credibility, but yes, I think you are mistaken about the size of the effect being reported. At low prevalence probabilities, odd ratios are more or less just multipliers on the prevalence probability. So if there is a 0.1% probability of developing Crohn's without childhood antibiotics, an odds ratio of 3.5 would mean that there is approximately an 0.35% probability of developing Crohn's with childhood antibiotics. That's 100 in 100k vs. 350 in 100k, and in my opinion that's not a small difference. More generally, an odds ratio is the ratio of the odds of something under two different sets of circumstances.

drewg123 4y ago

I have Crohn's and I remember my pediatrician as being very willing to prescribe meds at the drop of a hat. I still remember the oral antibiotics I had as a little kid in the 70s. So this would not surprise me. A lot of the theories I've heard of Crohn's is it happens because modern humans are too clean, germ free and not riddled with parasites, giving the immune system too much free time at which point it starts attacking the gut.

atwood22 4y ago
Another piece of supporting evidence: https://www.medicalnewstoday.com/articles/growing-up-with-a-dog-might-protect-against-crohns-disease#:~:text=Researchers%20observed%20that%20individuals%20who,the%20risk%20of%20Crohn's%20disease https://www.medicalnewstoday.com/articles/growing-up-with-a-.... Those that grow up with dogs may be less likely to develop Crohn's. Dogs have been shown to increase the strength of a child's immune system.

hunter-gatherer 4y ago

I'm glad this just came up. My ten-year old nephew has been in and out of hospital stays for the past 4 years and was just finally diagnosed with Crohn's and released from a long stay at the hospital this week. They've now got him on a diet that they claim seems to help a bit but I haven't seen it. As a result of having undiagnosed Crohn's for some years he has fallen behind in school, with friends, and so on. If anybody is aware of any support groups, diets, good doctors, or any advice in general for young kids with Crohn's, please post. I may not have time to respond but I'll definitely read through responses. If an email is more appropriate you can send one to qbwkmaz@protonmail.com. Thanks in advance.

timonovici 4y ago
In my case, medicine and diet had little effect. And I was in pretty bad shape, i got to the emergency room several times a week with awful abdominal pain, vomiting, constipation. A different doctor adviced me to eat anything I want, but for at least half a year to eat kefir with every meal. That worked. Whenever I feel like my digestive tract is getting funny, i add a few bottles of kefir for a few days.
- deleted 4y ago
  [deleted]
- danachow 4y ago
  You have actual Crohn's or IBS? Because your symptoms while distressing don't sound like Crohn's at all. Crohn's is an autoimmune inflammatory condition with actual tissue destruction. People with Crohn's flares don't show up to the ED with constipation, they often show up with profusely bloody diarrhea. Additionally weight loss and anemia. They may likely require admission for high dose steroids. People with Crohn's will often need surgery. What you're describing sounds more like IBS. A bottle of kefir is unlikely to hurt. However, I am quite skeptical that such a thing has any prophylactic effect once a recurrent process like Crohn's is set in motion - like pissing on a gasoline fire. A bottle of kefir is not going to touch an actual Crohn's flare at all. There's no good evidence that any specific diets seem to help the chronic course of Crohn's unfortunately, and it's not like no one has looked.

AugustusCrunch 4y ago

I have a child who had Crohns. This has been known since antibiotics were invented. All IBS conditions are caused by the wrong gut bacteria - typically c. diff - and the cure rate for fecal bacteriotherapy is about 95% in one shot. It's ludicrous that we're still studying this and acting as though it's such a mystery, while people suffer and die.

danachow 4y ago
You are confusing Crohn's, an inflammatory bowel condition that is life long and can often be disfiguring and requiring surgery with IBS which is completely unrelated, non-inflammatory (if it were then it would not be IBS), with distressing but not usually life limiting sequelae. Do you even know what IBS stands for? The fact is we do not understand the complete mechanisms of either Crohn's or IBS, but based on their presentation and treatment it is unlikely they are too closely related - and it is likely that IBS is itself due to multiple factors - hence it is a syndrome, not a disease. Given this, it is hogwash to say all of any kind of condition is caused by one thing. And if there was a cure with 95% effectiveness, I am sure many of the affluent IBS sufferers on this site would have figured it out by now. > and the cure rate for fecal bacteriotherapy is about 95% in one shot. It's ludicrous that we're still studying this and acting as though it's such a mystery. This is crackpottery.

rossdavidh 4y ago

On the one hand, it makes total sense to me that childhood antibiotics could mess up your digestive tract immune system. On the other hand: "Subgroup analysis showed that antibiotic use <18 years old was a risk factor for CD development in the Chinese (adjusted OR 4.80, 95% CI 1.62–12.24; P = 0.005) but not in Australian populations (OR 1.80, 95% CI 0.33–9.95; P = 0.498)." If it were a robust finding, it would not fall apart on subgroup analysis.

admiralpumpkin 4y ago
Actually the reverse, we should be skeptical of subgroup analyses, because they are often fishing for results, have issues with multiple comparisons, and are typically underpowered.
- deleted 4y ago
  [deleted]
xxpor 4y ago
Different antibiotics/doses/frequency of prescription in different countries? Haven't read the whole thing yet though.
- cpncrunch 4y ago
  Just look at the results table. Even for china it looks like only certain age ranges show the effect. Most likely just random.

popotamonga 4y ago

Happened to me. My doctor as a kid would just prescribed antibiotic for everything thing,no matter what. How can there be such bad doctors.

timonovici 4y ago
Yeah, i remember being prescribed ampicillin and aspirin for every cold, as a child. They didn't care, they only wanted to "do something". I remember in highschool having a colleague who's overprotective mother was also a germophobe, and was treating her only son with ever increasing doses of antibiotics every winter. By the time we met, pills had no effect(according to them, the hell knows what they meant by "effectiveness"), and he was getting intramuscular ones. The poor people probably never learned that there almost no antivirals, and are doing more harm that good. Antibiotics are thought to be a panacea around here, in eastern Europe.
dham 4y ago
They still do. It's literally insane. Most will prescribe oral for everything even if it's just a cut. Not only will they give antibiotics they won't even tell someone to take a probiotic during treatment. Most doctors I've met over the years just phone it in and don't stay up to date on anything.
- kube-system 4y ago
  It’s partially doctors giving in to the demands of patients who want a prescription for everything. I think it’s a side effect of our expensive healthcare system. People don’t like paying their copay for just a band aid. Or to be told “it’s a virus, get some sleep and drink fluids”. They want to feel like they got something for their money.
  - mirekrusin 4y ago
    That's why we now have homeopathy placebos in pharmacies.
swayvil 4y ago

codeTired 4y ago

The healthcare needs to be completely overhauled. So many doctors are completely ignorant of risks of antibiotics and other meds. There was a study that found 7% of doctors reported adverse reactions. Some were scared, some didn’t know how, some didn’t have time. Some doctors made no reports in nearly lifetime of practice. When I was 16-22 I had multiple 6+ months courses of doxycycline for acne. I have seen multiple dermatologist who said nothing can be done about my cystic acne. At some point I was tired of doxy making me feel awful so I researched different skin types and skin care routines. As long as I use a mild soap twice a day, use a moisturizer and don’t touch my skin I get 0 cystic acne but it took weeks to see the results. No doctor ever told me about different types of skin and I was young and dumb. My parents didn’t know any better. And internet wasn’t as popular back then. Then, I got an adverse reaction to cipro. And 40+ doctors ignored it. Told me it’s all in my head. Told me to seek help for my mental health and depression. Later FDA added warning about permanent nerve damage. I still have to send studies to doctors because they try to tell me I’m wrong, after I had every test under the sun to rule out other causes. I help admin flouroquinolone toxicity group and every day we get individuals who were given these last resort meds for suspected infection. It is border line medical malpractice. However, I have seen that it is impossible to find a lawyer to take the case and find a physician willing to testify. There needs to be a better system for tracking allergic reactions and trends. For example, cipro might show no reaction up to 6 months. Then, you snap your Achilles. The doctor won’t tell you it was cipro unless you tell him. It’s fucked and extremely underreported.

victorclf 4y ago
I research every prescribed treatment side effects after levofloxacin gave me bilateral achilles tendinitis. In my experience, potential side effects and complications from treatments are never discussed with patients. I also had the displeasure of suffering from the mental side effects of the antiallergic montelukast, which again were not even mentioned by the doctor despite the serious FDA warning.
ReptileMan 4y ago
>The healthcare needs to be completely overhauled. So many doctors are completely ignorant of risks of antibiotics and other meds. Doctors are well aware by my talks with them. There is unfortunately a large subset of the population that unless prescribed antibiotics feel that they have not been taken care by the doctor. So there is quite a demand.

Saint_Genet 4y ago

I suspect (but have no science to back it up) that it’s a risk factor for many things. I had ear infections more or less constantly in my childhood and were on antibiotics the whole time until they finally stooped working. The end result is that I’m now deaf on one ear. I get why they were prescribed, it stopped the acute pain but no one thought about the long term

PaulKeeble 4y ago

Antibiotics are actually really more damaging than we realise. Western digestive tracts show significant differences in microbiome that those of people who do not use antibiotics as treatment and some of the lost species are really important. We also have no way to fix it currently, some of the species like Faecalibacterium Prausnitzii are critical to our bodies energy system but can't survive in oxygen, so we have no way to eat it at all, you kill it then its gone likely for good. Others like Limosilactobacillus reuteri stop fungus from inhabiting our small intestine as well as other bacteria but just 5% of us still have some of it as its very susceptible to antibiotics. We don't know what ideal microbiomes look like, we just know the bulk of people living in the western world have unhealthy ones that are missing key species and we have only scratched the surface of understanding.

deleted 4y ago
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bobbylarrybobby 4y ago
How are bacteria that can't be eaten first acquired by infants?
- PaulKeeble 4y ago
  Passed to them from their mother while in the womb. Seems to be transferred at birth but there is some evidence it happens earlier too.
  - refurb 4y ago
    Source? Amniotic fluid and blood is sterile. Newborns acquire their biome once born by ingesting various food and contact from family members.
    - steve_adams_86 4y ago
      People imagine some special mechanism of transfer, but the reality is that we get bacteria from inside and outside of our bodies all over stuff, all the time, and we’re crawling with it. The babies would be introduced to GI tract flora pretty much immediately even if you tried to prevent it (unless you prevent it with antibiotics of course).

jamal-kumar 4y ago

I had really bad IBS from consuming water on a tropical island in Panama one time and suffered for a few years with even my doctor friend telling me "Damn that sucks, not much you can do except manage". Pretty horrible symptoms until I discovered L. Reuteri. [1] I read that it's been a bacteria that was more commonly found in samples until around the 1950s when people started consuming more garbage processed food and was sold. Simply stated, it changed my life. It emits a substance called Reuterin which inhibits the growth of other more harmful bacterial species. [2] I can't speak personally for suffering on the level of Crohn's disease, but there's positive research out there regarding it. [3] [4] [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5917019/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5917019/ [2] https://en.wikipedia.org/wiki/Reuterin https://en.wikipedia.org/wiki/Reuterin [3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7270012/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7270012/ [4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468961/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468961/

ng12 4y ago
> Damn that sucks, not much you can do except manage This has been my entire experience with gastroenterology as a field. Once they rule out cancer there's really not much they can do for you. Meanwhile, I'm waiting for the revolution in our understanding of the microbiome.
- kevinmchugh 4y ago
  I couldn't swallow pills before, my gastroenterologist performed surgery which corrected that. She also proscribed pills which address my GERD
  - ng12 4y ago
    That's fair. Guess I'm mostly talking about the other end of the system :)
    - danachow 4y ago
      There are actually biologic treatments for Crohn's/UC, not everyone responds but they produce remission which can spare or prolong time to surgery for many.

saiya-jin 4y ago

Wife is a internal doctor (Switzerland's biggest hospital), and we were very wary about avoiding giving any kind of antibiotics before our kids reached age of 1. Common knowledge among peer doctors is that even single usage before 12 months significantly increases risk of diabetes later in life significantly (and god knows what other nasty side effects). In some cases they are miracle cure, with some nasty side effects. But general over-prescription even in relatively developed world is ridiculous. From my less developed and highly corrupt home (Slovakia/Czech republic), I often get news from friends who got prescribed full course of antibiotics on clearly viral infections. General doctors there are mostly on such an abysmal level that self-treatment is sometimes better than their clueless visits. Even for small kids. Another item are painkillers - I see prescriptions for literally anything, usually heavy doses of paracetamol or ibuprofen but I've seen worse for maladies which don't warrant it. I don't even take those in pharmacies unless I know I have acute inflammation to treat.

Daniel_sk 4y ago
My wife is a GP in Slovakia and she has a device for a quick test (CRP) whether you have a bacterial infection in blood or not. So they don’t prescribe antibiotics if the test is negative. And she doesn’t recommend them if not necessary - unfortunately many patients demand them because that’s what they expect to get. But she is maybe an exemption who cares a lot about each patient and invests into better equipment even though you are not really incentivized by the system to do so.

refurb 4y ago

Well when your kid is screaming in pain from an ear infection, I'm not sure I'm going to decline to treat them with antibiotics because of some small future risk of Crohn's disease.

weberer 4y ago
Maybe just give them topical antibiotics?
- refurb 4y ago
  Topical antibiotics won't penetrate the inner ear. You can use drops for outer ear infections, but if it's on the other side of the ear drum, it needs to be oral antibiotics.
  - ls15 4y ago
    The other side of the ear drum is directly connected to the respiratory system though. It may not be good advice and children probably would hate it, but I am pretty sure that sniffing small drops of hydrogen peroxide solution helped with my ear infections.
    - refurb 4y ago
      Typically if a child has a middle ear infection, the eustachian tube is blocked. Otherwise the pressure from the infection would just drain through the back of the nose.
- ls15 4y ago
  Or even disinfectants instead of antibiotics. I've been using a few drops of hydrogen peroxide for ear infections forever and it always took care of them. Why would I want to disturb my entire microbiome for a small local infection?
nsgi 4y ago
Does the study recommend antibiotics not be used to treat ear infections? I would think the message is that it's even more important not to use antibiotics when they're not needed, not that they shouldn't be used at all

sk8terboi 4y ago