Editorial: Association of Antibiotic Exposure With Microscopic Colitis

Alimentary Pharmacology & Therapeutics, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 21, 2025

Soon after microscopic colitis (MC) was first described, reports emerged of cases that appeared to be due the use certain medications. As case accumulated, topic gained further attention. At one point, a sophisticated imputation score created in an attempt assess likelihood causality particular drug or class as cause MC with conclusion eight drugs classes had high inducing and seven intermediate risk [1]. Combinations these drugs, such non-steroidal anti-inflammatory (NSAIDs) together proton pump inhibitors (PPIs), may exacerbate [2-4]. In addition drug-induced scoring systems, various other clinical predictive models have been proposed identify patients unlikely whom colon biopsies can potentially avoided. More recently, immune checkpoint used oncology also associated development [5]. A meta-analysis 12 case–control studies demonstrated modest odds ratios suggesting exposure NSAIDs, PPIs, SSRIs aspirin incidence [6]. However, several evaluating this association significantly mitigated when controls diarrhoea—rather than healthy subjects—were for comparison [7, 8] indicating some medications not causative but, rather, exacerbating diarrhoea thereby bringing milder medical Szilcz colleagues reported antibiotic large national study older adults Sweden [9]. To control detection bias, they performed analysis between normal biopsies. group, even stronger observed probably bias. Similar discussed above, results reinforce need consider group studying associations MC. Therefore, accumulating evidence linking medication indicates many more confounded causal [10]. This observation has important implications understanding underlying pathophysiological mechanisms underpinning clinicians caring are less clear. Specifically, if patient is being evaluated diarrhoea, whether biopsy-proven not, careful review their list, including over-the-counter medications, essential. If any might temporally onset consideration should given stopping it and, necessary, switching another similar effects but ideally from different family. patients, will resolve at least improve easier manage anti-diarrhoeal therapy rather corticosteroids immunomodulatory June Tome: writing – original draft, editing. Darrell S. Pardi: conceptualization, article linked et al papers. view articles, visit https://doi.org/10.1111/apt.70028 https://doi.org/10.1111/apt.70056. Data sharing applicable no datasets were generated analysed during current study.

Language: Английский

Editorial: Association of Antibiotic Exposure With Microscopic Colitis—Authors' Reply

Alimentary Pharmacology & Therapeutics, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 25, 2025

We thank Drs. Tome and Pardi for their editorial on our study examining the association between antibiotic exposure microscopic colitis (MC) [1]. appreciate careful literature review insightful discussion regarding potential confounding factors that may influence observed relationship drug exposures MC. As highlighted, studies investigating medications associated with MC have consistently encountered challenges in disentangling causation from confounding. aimed to address this through a self-controlled design [2], which cases acted as own controls, thereby mitigating important confounders, such genetic predisposition, are difficult account traditional cohort [3]. In where external controls necessary, matching by clinical characteristics healthcare engagement patterns can further reduce confounding, strengthening causal inference. However, we acknowledge detection bias remains consideration. Patients experiencing gastrointestinal symptoms certain (e.g., antibiotics) be more likely undergo endoscopic evaluation, increasing detection. Medication often occur combination, particularly older adults. These combinations antibiotics combined non-steroidal anti-inflammatory drugs or proton pump inhibitors) amplify side effects. The interplay of multiple complicates challenge establishing direct link any single medication Future research should investigate impact polypharmacy incidence severity, ideally prospective, longitudinal rigorous selection control groups. Looking ahead, comprehensive needed understand how various alter intestinal environment, contributing development. One option is gut microbiome's role antibiotic-induced dysbiosis prime colonic mucosa an aberrant immune response. Incorporating stool metagenomics, mucosal immunologic markers, detailed pharmacokinetic/pharmacodynamic data into prospective could provide crucial insights pathophysiology Such investigations pave way precision medicine approaches, enabling targeted interventions based microbiome profiles, pathways, predispositions prevent mitigate high-risk individuals [4]. Large-scale analyses using real-world evidence electronic health record-based pharmacoepidemiologic help identify at-risk subgroups effectively. This might include adults comorbidities, specific backgrounds, patients requiring complex regimens. By leveraging big analytics, future move beyond broad associations generate actionable risk prediction models, ultimately guiding clinicians safer prescribing practices. Finally, join emphasising meticulous both prescription over-the-counter essential patient newly diagnosed Even if definitive causality agent challenging establish, clinically guided deprescribing switching alternative lead meaningful symptom improvement [5]. again valuable perspective. Their synthesis current knowledge has underscored need continued collaboration better drug-related underpinnings hope study, alongside editorial, will encourage critical inquiry optimise management strategies these patients. Máté Szilcz: conceptualization, formal analysis, project administration, writing – original draft, editing, methodology, software, visualization. Jonas W. Wastesson: methodology. David Bergman: Kristina Johnell: supervision, funding acquisition, editing. F. Ludvigsson: article linked Szilcz et al papers. To view articles, visit https://doi.org/10.1111/apt.70028 https://doi.org/10.1111/apt.70043. Data sharing not applicable no new were created analyzed study.

Language: Английский