Antibiotic exposure and the risk of colorectal adenoma and carcinoma: a systematic review and meta‐analysis of observational studies

Aim The Incidence of colorectal cancer (CRC) is increasing, and evidence suggests that maladaptation of the bowel microbiome may be associated with colorectal carcinogenesis. Consumption of antibiotics may cause imbalance of the bowel microbiome but research assessing an association between antibiot...

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Veröffentlicht in:Colorectal disease 2020-08, Vol.22 (8), p.858-870
Hauptverfasser: Sanyaolu, L. N., Oakley, N. J., Nurmatov, U., Dolwani, S., Ahmed, H.
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container_end_page 870
container_issue 8
container_start_page 858
container_title Colorectal disease
container_volume 22
creator Sanyaolu, L. N.
Oakley, N. J.
Nurmatov, U.
Dolwani, S.
Ahmed, H.
description Aim The Incidence of colorectal cancer (CRC) is increasing, and evidence suggests that maladaptation of the bowel microbiome may be associated with colorectal carcinogenesis. Consumption of antibiotics may cause imbalance of the bowel microbiome but research assessing an association between antibiotic exposure and CRC is inconsistent. The aim of this systematic review and meta‐analysis was to appraise and synthesize the available evidence. Method The MEDLINE, EMBASE and CINAHL databases were searched for published observational studies. We included eight studies of 3 408 312 patients. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) for the odds of CRC following antibiotic exposure were estimated. Sensitivity analyses were performed according to exposure definition, study design and risk of bias. Results A weak association between antibiotic exposure and CRC was demonstrated when exposure was assessed cumulatively by the number of prescriptions (OR 1.204, 95% CI 1.097–1.322, P 
doi_str_mv 10.1111/codi.14921
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N. ; Oakley, N. J. ; Nurmatov, U. ; Dolwani, S. ; Ahmed, H.</creator><creatorcontrib>Sanyaolu, L. N. ; Oakley, N. J. ; Nurmatov, U. ; Dolwani, S. ; Ahmed, H.</creatorcontrib><description>Aim The Incidence of colorectal cancer (CRC) is increasing, and evidence suggests that maladaptation of the bowel microbiome may be associated with colorectal carcinogenesis. Consumption of antibiotics may cause imbalance of the bowel microbiome but research assessing an association between antibiotic exposure and CRC is inconsistent. The aim of this systematic review and meta‐analysis was to appraise and synthesize the available evidence. Method The MEDLINE, EMBASE and CINAHL databases were searched for published observational studies. We included eight studies of 3 408 312 patients. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) for the odds of CRC following antibiotic exposure were estimated. Sensitivity analyses were performed according to exposure definition, study design and risk of bias. Results A weak association between antibiotic exposure and CRC was demonstrated when exposure was assessed cumulatively by the number of prescriptions (OR 1.204, 95% CI 1.097–1.322, P &lt; 0.001) or duration of antibiotic exposure (OR 1.168, 95% CI 1.087–1.256, P &lt; 0.001). Antibiotic exposure assessed as a binary variable demonstrated no association with CRC. Conclusion The findings suggest a weak association between cumulative antibiotic consumption and risk of CRC but no causal conclusions can be made. Limitations include the heterogeneity and quality of the available research, particularly with regard to measurement of antibiotic exposure.</description><identifier>ISSN: 1462-8910</identifier><identifier>EISSN: 1463-1318</identifier><identifier>DOI: 10.1111/codi.14921</identifier><identifier>PMID: 31802593</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Adenoma ; Antibiotics ; anti‐bacterial agents ; Carcinogenesis ; colorectal adenoma ; Colorectal cancer ; Colorectal carcinoma ; gastrointestinal neoplasms ; Intestine ; Meta-analysis ; Microbiomes ; Observational studies ; Sensitivity analysis ; Systematic review</subject><ispartof>Colorectal disease, 2020-08, Vol.22 (8), p.858-870</ispartof><rights>Colorectal Disease © 2019 The Association of Coloproctology of Great Britain and Ireland</rights><rights>Colorectal Disease © 2019 The Association of Coloproctology of Great Britain and Ireland.</rights><rights>Copyright © 2020 The Association of Coloproctology of Great Britain and Ireland</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3931-efa94f1e4f3c7d6904c95d75f6ddc0734d672871b4b42351e175839e9ff19e6e3</citedby><cites>FETCH-LOGICAL-c3931-efa94f1e4f3c7d6904c95d75f6ddc0734d672871b4b42351e175839e9ff19e6e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fcodi.14921$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fcodi.14921$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27923,27924,45573,45574</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31802593$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sanyaolu, L. N.</creatorcontrib><creatorcontrib>Oakley, N. J.</creatorcontrib><creatorcontrib>Nurmatov, U.</creatorcontrib><creatorcontrib>Dolwani, S.</creatorcontrib><creatorcontrib>Ahmed, H.</creatorcontrib><title>Antibiotic exposure and the risk of colorectal adenoma and carcinoma: a systematic review and meta‐analysis of observational studies</title><title>Colorectal disease</title><addtitle>Colorectal Dis</addtitle><description>Aim The Incidence of colorectal cancer (CRC) is increasing, and evidence suggests that maladaptation of the bowel microbiome may be associated with colorectal carcinogenesis. Consumption of antibiotics may cause imbalance of the bowel microbiome but research assessing an association between antibiotic exposure and CRC is inconsistent. The aim of this systematic review and meta‐analysis was to appraise and synthesize the available evidence. Method The MEDLINE, EMBASE and CINAHL databases were searched for published observational studies. We included eight studies of 3 408 312 patients. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) for the odds of CRC following antibiotic exposure were estimated. Sensitivity analyses were performed according to exposure definition, study design and risk of bias. Results A weak association between antibiotic exposure and CRC was demonstrated when exposure was assessed cumulatively by the number of prescriptions (OR 1.204, 95% CI 1.097–1.322, P &lt; 0.001) or duration of antibiotic exposure (OR 1.168, 95% CI 1.087–1.256, P &lt; 0.001). Antibiotic exposure assessed as a binary variable demonstrated no association with CRC. Conclusion The findings suggest a weak association between cumulative antibiotic consumption and risk of CRC but no causal conclusions can be made. Limitations include the heterogeneity and quality of the available research, particularly with regard to measurement of antibiotic exposure.</description><subject>Adenoma</subject><subject>Antibiotics</subject><subject>anti‐bacterial agents</subject><subject>Carcinogenesis</subject><subject>colorectal adenoma</subject><subject>Colorectal cancer</subject><subject>Colorectal carcinoma</subject><subject>gastrointestinal neoplasms</subject><subject>Intestine</subject><subject>Meta-analysis</subject><subject>Microbiomes</subject><subject>Observational studies</subject><subject>Sensitivity analysis</subject><subject>Systematic review</subject><issn>1462-8910</issn><issn>1463-1318</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kMtu3CAUQFHVqHlu8gEVUneRnHANNqa7aNo8pEjZtGsLw0UhtYcp2Elnl1XX_cZ-SfBMkmXYwIWjI3QIOQZ2CnmdmWD9KQhVwgeyB6LmBXBoPm7OZdEoYLtkP6V7xqCW0Hwiu_mZlZXie-Tv-XL0nQ-jNxT_rEKaIlK9tHS8Qxp9-kWDoyb0IaIZdU-1xWUY9AYxOho_T1-ppmmdRhz07In44PFxgww46v9P__RS9-vk0ywLXcL4kMGQL2kaJ-sxHZIdp_uERy_7Afl58f3H4qq4ub28XpzfFIYrDgU6rYQDFI4baWvFhFGVlZWrrTVMcmFrWTYSOtGJkleAIKuGK1TOgcIa-QH5svWuYvg9YRrb-zDF_JHUloIzJmWOlKmTLWViSCmia1fRDzquW2DtnLydk7eb5Bn-_KKcugHtG_raOAOwBR59j-t3VO3i9tv1VvoMLKiOvA</recordid><startdate>202008</startdate><enddate>202008</enddate><creator>Sanyaolu, L. 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J.</creatorcontrib><creatorcontrib>Nurmatov, U.</creatorcontrib><creatorcontrib>Dolwani, S.</creatorcontrib><creatorcontrib>Ahmed, H.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><jtitle>Colorectal disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sanyaolu, L. N.</au><au>Oakley, N. J.</au><au>Nurmatov, U.</au><au>Dolwani, S.</au><au>Ahmed, H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Antibiotic exposure and the risk of colorectal adenoma and carcinoma: a systematic review and meta‐analysis of observational studies</atitle><jtitle>Colorectal disease</jtitle><addtitle>Colorectal Dis</addtitle><date>2020-08</date><risdate>2020</risdate><volume>22</volume><issue>8</issue><spage>858</spage><epage>870</epage><pages>858-870</pages><issn>1462-8910</issn><eissn>1463-1318</eissn><abstract>Aim The Incidence of colorectal cancer (CRC) is increasing, and evidence suggests that maladaptation of the bowel microbiome may be associated with colorectal carcinogenesis. Consumption of antibiotics may cause imbalance of the bowel microbiome but research assessing an association between antibiotic exposure and CRC is inconsistent. The aim of this systematic review and meta‐analysis was to appraise and synthesize the available evidence. Method The MEDLINE, EMBASE and CINAHL databases were searched for published observational studies. We included eight studies of 3 408 312 patients. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) for the odds of CRC following antibiotic exposure were estimated. Sensitivity analyses were performed according to exposure definition, study design and risk of bias. Results A weak association between antibiotic exposure and CRC was demonstrated when exposure was assessed cumulatively by the number of prescriptions (OR 1.204, 95% CI 1.097–1.322, P &lt; 0.001) or duration of antibiotic exposure (OR 1.168, 95% CI 1.087–1.256, P &lt; 0.001). Antibiotic exposure assessed as a binary variable demonstrated no association with CRC. Conclusion The findings suggest a weak association between cumulative antibiotic consumption and risk of CRC but no causal conclusions can be made. 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subjects Adenoma
Antibiotics
anti‐bacterial agents
Carcinogenesis
colorectal adenoma
Colorectal cancer
Colorectal carcinoma
gastrointestinal neoplasms
Intestine
Meta-analysis
Microbiomes
Observational studies
Sensitivity analysis
Systematic review
title Antibiotic exposure and the risk of colorectal adenoma and carcinoma: a systematic review and meta‐analysis of observational studies
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