Self-reported gluten/wheat sensitivity is more common in women and people with irritable bowel syndrome, anxiety and depression

Around one in ten people worldwide report gastrointestinal and other symptoms such as fatigue and headache after eating foods containing gluten or wheat despite not having a diagnosis of either coeliac disease or wheat allergy, finds a large systematic review and meta-analysis published online in Gut.

These people have a condition known as non-coeliac gluten/wheat sensitivity (NCGWS), which appears to be more common in women and associated with irritable bowel syndrome, anxiety and depression.

Symptoms of NCGWS tend to improve when gluten or wheat is avoided and recur when foods containing them are returned to the diet. However, in contrast to coeliac disease and wheat allergy, the disease process underpinning NCGWS is unclear and it has no specific associated blood markers, making diagnosis challenging.

Currently NCGWS is diagnosed by excluding coeliac disease and wheat allergy in individuals who report adverse symptoms after eating gluten or wheat, and little is known about the prevalence and presenting clinical features.

To address this, the authors identified all studies published between 2014 and 2024 evaluating the prevalence of self-reported NCGWS in the general population. Twenty five studies including 49,476 participants from 16 countries met the inclusion criteria and these data were extracted for use in their pooled analysis.

The results of this analysis showed the overall prevalence of self-reported NCGWS was 10.3% but that distinct differences in prevalence were evident between individual countries. Prevalence varied from 0.7% in Chile to 23% in the UK and 36% in Saudi Arabia.

The data also revealed that four in ten people reporting NCGWS followed a gluten-free diet to avoid gastrointestinal and other troublesome symptoms, often doing so in the absence of formal medical advice or a diagnosis.

The most common symptoms reported by participants were bloating (71%), abdominal discomfort (46%), abdominal pain (36%) and fatigue (32%). Other symptoms reported included diarrhoea, constipation, headache and joint pain.

In addition, self-reported NCGWS was significantly more common in women and significantly more likely to occur in people reporting anxiety, depression and irritable bowel syndrome.

The authors acknowledge the study had several limitations including its reliance on self-reporting of NCGWS by participants, that some of the authors had contributed to a subset of studies included in the meta-analysis, and that substantial differences in prevalence between the studies included could not be fully explained by regression analyses. They suggest these differences in prevalence could reflect variability in diagnostic criteria and confounding factors or be true differences in prevalence across populations and countries.

Nevertheless, the authors conclude, “Self-reported non-coeliac gluten/wheat sensitivity affects approximately one in ten people worldwide, with a considerable geographical variation and strong association with female sex, psychological distress and irritable bowel syndrome.”

They add that non-coeliac gluten/wheat sensitivity needs to be recognised within the disorders of the gut-brain interaction framework – a neurogastroenterology concept that emphasises the bidirectional communication between the gut and the brain – and symptom-based diagnostic criteria developed “to guide a more tailored management approach focusing on individual symptom patterns and dietary triggers beyond gluten and to reduce unnecessary dietary restriction in this common condition”.

28/10/2025

Notes for editors
Research: Global prevalence of self-reported non-coeliac gluten and wheat sensitivity: a systematic review and meta-analysis  Doi: 10.1136/gutjnl- 2025-336304
Journal: Gut

About the journal
Gut is one of 70 journals published by BMJ Group. The title is co-owned with the British Society of Gastroenterology
https://gut.bmj.com

External funding: None declared

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Systematic review + meta analysis
Subjects: People

The post One in ten people without coeliac disease or wheat allergy report sensitivity to gluten or wheat first appeared on BMJ Group.

High fibre, low red meat diet, no smoking, regular exercise, normal weight, all key

Maintaining a healthy lifestyle—specifically, a diet rich in fibre but light on red/processed meat, regular exercise, not smoking, and sticking to a normal weight—is linked to a significantly lower risk of diverticulitis, finds a large long term study, published online in the journal Gut.

What’s more, these 5 components seem to offset the effects of inherited genes, the findings indicate.

Diverticulitis occurs when ‘pouches’ develop along the gut and become inflamed or infected in the wall of the large intestine (colon), explain the researchers. It’s a common cause of hospital admissions and a major reason for emergency colon surgery, they add.

Genetic and environmental factors, including lifestyle, contribute to the development of the condition, but it’s not clear exactly how these factors interact or the extent to which lifestyle might offset the genetic risk, they say.

To shed more light on this, the researchers derived an overall healthy lifestyle score (0-5) for diverticulitis from survey responses for 179,564 participants drawn from three prospective studies: the Nurses’ Health Study (NHS), NHSII, and the Health Professionals Follow-Up Study.

The score was based on 5 elements that have independently been associated with heightened risks of developing diverticulitis: smoking; weight (BMI); physical activity; fibre intake; and red/processed meat intake.

The association between this score and incident diverticulitis was confirmed among 30,750 participants in the Southern Community Cohort Study (SCCS).

Genetic risk was assessed using a polygenic risk score (PRS) in 36,077 people with available genotype information.

During a monitoring period of 20 years, 10,299 new cases of diverticulitis were recorded. The 5 lifestyle factors were each significantly associated with the development of the condition.

For example, compared with participants with a BMI below 25, those who were overweight were 32% more likely to develop diverticulitis, while those who were obese were 44% more likely to do so.

Participants who had formerly or who were still smoking were, respectively, 17% and 13% more likely to be diagnosed with diverticulitis than those who had never smoked. And higher levels of physical activity were associated with a 16% reduced risk compared with lower levels.

While higher fibre intake was associated with a 14% lower risk, higher red meat intake was associated with a 9% increased risk.

And every 1-point increase in healthy lifestyle score was associated with a 12% lower risk of diverticulitis. Participants with a score of 5 were 50% less likely to be diagnosed with the condition than those with a score of 0.

The findings were consistently observed across all three studies and in different racial groups.

The association between healthy lifestyle score and incident diverticulitis was confirmed among 30,750 participants in the Southern Community Cohort Study (SCCS).

Some 2183 new cases of diverticulitis were reported during an average monitoring period of nearly 12 years in this group. Those with a healthy lifestyle score of 3–5 had a substantially lower risk (31%) than those with a score of 0.

Genetic risk was assessed using a polygenic (cumulative) risk score (PRS) in 36,077 people with available genotype information in the NHS, NHSII, and HPFS groups.

There were no notable differences in lifestyle factors across PRS categories, but PRS was significantly associated with incident diverticulitis. For each unit increase in PRS, the risk increased by 58%, and was particularly evident among those under the age of 60.

And a healthy lifestyle seemed to offset genetic susceptibility to the condition. For example, those in the lowest PRS category and with a healthy lifestyle score of 4-5 were 37% less likely to develop diverticulitis compared to those with a score of 0.

Similarly, those with a medium PRS were 48% less likely to do so, while those in the highest PRS category were 50% less likely to do so. Further analysis showed that adopting a healthy lifestyle might prevent 23–42% of diverticulitis cases across PRS categories.

And when the effect of PRS and a healthy lifestyle score were combined, those in the highest PRS category with a healthy lifestyle score of 0 or 1 were 5 times more likely to develop diverticulitis than those in the lowest PRS category with a score of 4 or 5.

The findings were further validated in the Mass General Brigham Biobank (MGBB).

This is an observational study, and as such, can’t establish cause. And the researchers acknowledge that ascertainment of diverticulitis was based on different approaches across the different studies.

Nevertheless, they conclude: “Our data provide consistent evidence from multiple data sets indicating that adherence to a healthy lifestyle is linked to a reduced risk of developing diverticulitis, irrespective of one’s genetic predisposition.”

02/07/2025

Notes for editors
Research: Lifestyle factors, genetic susceptibility and risk of incident diverticulitis: an integrated analysis of four prospective cohort studies and electronic health records-linked biobank  Doi: 10.1136/gutjnl-2025-335364

Journal: Gut

External funding: National Institutes of Health (NIH) and American Gastroenterological Association.

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: People

The post Healthy lifestyle linked to lower diverticulitis risk, irrespective of genetic susceptibility first appeared on BMJ Group.

Aggressive and pro-inflammatory bacteria and COVID-19 virus possible culprits

Irritable bowel syndrome (IBS)—characterised by abdominal pain, bloating, and altered bowel habit—may last 4 or more years following a bout of gastroenteritis in around half of those affected, finds a pooled data analysis of the available evidence, published online in the journal Gut.

Aggressive and pro-inflammatory bacteria, such as Proteobacteria and Enterobacteriaceae, and the virus responsible for COVID-19 infection, SARS-CoV-2, are possible culprits, the findings suggest.

IBS and recurrent indigestion of unknown cause (functional dyspepsia), are disorders of the gut-brain axis. Although common worldwide, their causes remain poorly understood, note the researchers.

But a sudden bout of gastroenteritis, usually brought on by a viral infection or food poisoning, is thought to be one of the possible triggers, explain the researchers, who add that an estimated 179 million people around the globe succumb to gastroenteritis every year.

To explore this further, they trawled research databases, looking for published studies on the development of IBS or functional dyspepsia after a bout of gastroenteritis in people monitored for at least 3 months after the episode.

From a haul of 75 eligible studies, 45, involving a total of 21870 people mostly from Europe and North America, were suitable for pooled data analysis. Sixteen studies were judged to be of high quality, with the rest judged to be of fair quality.

The prevalence of IBS after a bout of gastroenteritis was 14.5%. This was based on 46 studies involving 14,446  people. And the prevalence of functional dyspepsia was nearly 13%, based on 13 studies involving 5636 people.

Compared with those who had not had gastroenteritis, those who had were more than 4 times as likely to develop IBS and 3 times as likely to develop functional dyspepsia afterwards.

There were insufficient data to pool study results for the length of time functional dyspepsia persisted after gastroenteritis, but the pooled data analysis for IBS indicated that symptoms had persisted for between  6 and 11 months in 100 out of 201 people (50%) in 5 studies, and for 1-4 years in 125 out of 239 (52%) people in 3 studies.

And symptoms lasted for more than 5 years in 187 out of 471 (40%) people in 4 studies.

 The pooled data analysis pointed to certain risk factors for developing IBS after a bout of gastroenteritis, the most influential of which was a history of anxiety: this was associated with a three-fold heightened risk.

Diarrhoea lasting more than 3 weeks was associated with more than double the risk, while admission to hospital and female sex  were associated with, respectively, 65% and 59% heightened risks.

Analysis of the infectious agents involved showed that viruses were implicated in nearly 11% of cases (13 studies; 3585 people), bacteria in just over 18% (20 studies; 7050 people), and parasites in 30% (2 studies of 779 people).

The highest prevalence of IBS following gastroenteritis was associated with Campylobacter infection (21%), reported by 6 studies. And the odds of developing IBS were 5 times as high after a Proteobacteria species infection and 4 times as high for infection with Enterobacteriaceae species. Those infected with SARS-CoV-2 or parasites were 5 times as likely to develop IBS.

The prevalence of functional dyspepsia following gastroenteritis was nearly 14% for bacterial infections (4 studies; 759 people) and 10%  for SARS-CoV-2 infection (5 studies; 1269 people), with Enterobacteriaceae species, the most common source of infection.

Although theirs is the largest pooled data analysis to date of the prevalence of IBS and functional dyspepsia after a bout of gastroenteritis, the researchers acknowledge various limitations to their findings.

The study design, definitions used, participant numbers and length of follow-up varied considerably among the included studies. And most of the studies focused on Western populations, with limited data from the Asia-Pacific region and Africa. And there was no microbiological evidence of gastroenteritis in several of the studies.

But the researchers point out: “The pathophysiology of [disorders of gut-brain interaction] is poorly understood, and these disorders are traditionally perceived by healthcare professionals as being mostly psychological and less ‘valid’ diseases, with a potential risk of underestimating patients’ expectations and complaints.”

And they conclude: “Generally, as acute gastroenteritis is a common disorder worldwide, our findings may be relevant for public health, and physicians should pay heed if their patients present with a recent episode of infectious gastroenteritis.”

17/07/2024

Notes for editors
Research: Prevalence of irritable bowel syndrome and functional dyspepsia after acute gastroenteritis: systematic review and meta-analysis Doi: 10.1136/gutjnl-2023-331835
Journal: Gut

External funding: Italian Ministry of Health; Italian Ministry of Education, University and Research (MUIR)

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf 

Externally peer reviewed? Yes
Evidence type: Systematic review + meta analysis
Subjects: People

The post IBS following gastroenteritis may last 4+ years in around half of those affected first appeared on BMJ Group.

Especially not smoking, plenty of vigorous exercise, and getting enough sleep

Adopting a healthy lifestyle is strongly linked to a lower risk of irritable bowel syndrome or IBS for short, finds research published online in the journal Gut.

Of the big 5 healthy behaviours, not smoking, a high level of vigorous physical activity, and getting enough sleep were independently associated with keeping the condition at bay.

Characterised by abdominal pain, bloating, and abnormal bowel habit, IBS is thought to affect up to 1 in 10 people worldwide. Exactly what causes IBS isn’t fully understood, but disordered functioning of the gut–brain axis has a key role in the symptoms, explain the researchers.

Previously published research has linked individual lifestyle factors with a heightened risk of IBS, and the researchers wanted to find out if a combination of these factors might ward off the condition.

They therefore looked at the big 5 healthy behaviours—never smoking; at least 7 hours of sleep every night; a high level of vigorous physical activity every week; a high quality balanced diet every day; and moderate alcohol intake—among middle aged participants (average age 55) of the UK Biobank.

The final analysis included 64,286 people, just over half of whom (55%) were women, and who had completed at least two 24-hour dietary recall questionnaires.

During an average monitoring period of just over 12.5 years, 961 (1.5%) cases of IBS were recorded. 

Of the total sample, 7604 (12%) said they didn’t do any of the 5 healthy lifestyle behaviours, while 20,662 (32%) reported one; 21,901 (34%) reported two; and 14,101 (22%) reported 3 to 5 behaviours at the start of the monitoring period.

After accounting for potentially influential factors, the higher the number of healthy behaviours, the lower was the risk of IBS.

One behaviour was associated with a 21% lower risk, while 2 were associated with a 36% lower risk; and 3 to 5 were associated with a 42% lower risk.

Although of a smaller size than when combined, 3 healthy behaviours were independently associated with a lower risk of IBS: never smoking (14% lower); high level of physical activity (17% lower); and a good night’s sleep (27% lower).

Further in depth analysis showed that these associations were independent of age, sex, employment status, residential area, gut infection, family history of IBS or other lifestyle choices.

This is an observational study, and as such, can’t establish cause, added to which it relied on self-report, which may not always be accurate and older people, so may not be applicable to younger age groups. Nor was it possible to account for any lifestyle changes over time during the monitoring period.

Nevertheless, the researchers point out: “Although lifestyle modification is recommended as a means of managing IBS symptoms,  its potential role in preventing the onset of the condition has not been given due attention.” 

And they conclude: “IBS has a complex aetiology, involving biological, genetic, psychosocial and environmental factors. Our findings underscore the value of lifestyle modification in the primary prevention of IBS and suggest that healthy lifestyle choices could significantly attenuate the effects of aetiological factors on the incidence of IBS.”

Notes for editors
Research: Association of healthy lifestyle behaviours with incident irritable bowel syndrome: a large population-based prospective cohort study doi: 10.1136/gutjnl-2023-331254
Journal: Gut

Funding: National Key R&D Program of China; National Natural Science Foundation of China

Link to Academy of Medical Sciences labelling system
http://press.psprings.co.uk/AMSlabels.pdf 

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: People

The post Adopting healthy lifestyle strongly linked to lower irritable bowel syndrome risk first appeared on BMJ Group.

Diet rich in fish and veg, low in sugar-sweetened drinks at age of 1 may be key to protection
May be time for doctors to recommend ‘preventive’ diet for infants, editorialist suggests

A high quality diet at the age of 1 may curb the subsequent risk of inflammatory bowel disease, suggests a large long term study, published online in the journal Gut.

Plenty of fish and vegetables and minimal consumption of sugar-sweetened drinks at this age may be key to protection, the findings indicate.

A linked editorial suggests that it may now be time for doctors to recommend a ‘preventive’ diet for infants, given the mounting evidence indicative of biological plausibility.

Cases of inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis, are increasing globally. Although there is no obvious explanation for this trend, changes in dietary patterns are thought to have a contributory role, because of their impact on the gut microbiome.

While various studies have looked at the influence of diet on IBD risk in adults, there is little in the way of research on the potential influence of early childhood diet on risk.

In a bid to plug this knowledge gap, the researchers drew on survey data from the All Babies in Southeast Sweden study (ABIS) and The Norwegian Mother, Father and Child Cohort Study (MoBa).

ABIS includes 21,700 children born between October 1997 and October 1999; MoBa includes 114, 500 children, 95,200 mothers, and 75,200 fathers recruited from across Norway between 1999 and 2008.

Parents were asked specific questions about their children’s diet when they were aged 12-18 months and 30-36 months. The final analysis included dietary information for 81,280 1 year olds: 11,013 (48% girls) from ABIS and 70, 267 (49% girls) from MoBa.

Diet quality, gleaned from measuring intake of meat, fish, fruit, vegetables, dairy, sweets, snacks, and drinks, was assessed using a modified version of the Healthy Eating Index (HEI) scoring system, adapted for children. The weekly frequency of specific food groups was also assessed.

Higher diet quality—a higher intake of vegetables, fruit, and fish, and a lower intake of meat, sweets, snacks, and drinks—was reflected in a higher HEI score.The total score was divided into thirds to indicate a low, medium, or high quality diet. 

Data on age at weaning, antibiotic use, and formula feed intake were also reported at age 12 (ABIS) and 18 months (MoBa).

The children’s health was monitored for an average of 21 (ABIS) and 15 (MoBa) years from the age of 1 until 31 December 2020-21. 

During this period, 307 children were diagnosed with IBD (131 with Crohn’s disease; 97 with ulcerative colitis; and 79 with unclassified IBD). The average age at diagnosis was 17 (ABIS) and 12 (MoB).

Medium and high quality diets at the age of 1 were associated with an overall 25% lower risk of IBD compared with a low quality diet at this age, after adjusting for potentially influential factors, such as parental history of IBD, the child’s sex, ethnic origin, and education and co-existing conditions in the mother.

Specifically, high fish intake at the age of 1 was associated with a lower overall risk compared with its opposite, and a 54% lower risk of ulcerative colitis in particular. 

Higher vegetable intake at 1 year of age was also associated with a reduced risk of IBD. On the other hand, consumption of sugar-sweetened drinks was associated with a 42% heightened risk. 

There were no obvious associations between any of the other food groups, including meat, dairy, fruit, grains, potatoes and foods high in sugar and/or fat, and overall IBD or Crohn’s disease or ulcerative colitis risks.

By the age of 3, only high fish intake was associated with reduced IBD risk, and ulcerative colitis in particular.

The findings remained unchanged after accounting for household income and the child’s formula intake and antibiotic use by the age of 1.

This is an observational study, and as such, can’t establish cause. And the researchers acknowledge that while the ABIS participation rate was high (79%), it was only 41% for MoBa. And because Sweden and Norway are two high-income countries, findings may not be generalisable to low- or middle-income countries with other dietary habits, they add.

“While non-causal explanations for our results cannot be ruled out, these novel findings are consistent with the hypothesis that early-life diet, possibly mediated through changes in the gut microbiome, may affect the risk of developing IBD,” they conclude.

In a linked editorial, gastroenterologist Dr Ashwin Ananthakrishnan of Massachusetts General Hospital, Boston, USA, cautions that the questionnaires didn’t capture elements, such as additives and emulsifiers which are common in baby food, and which may contribute to the development of IBD. 

Accurate measures of food intake in infants and young children are inherently fraught with difficulty, he adds.

But he goes on to say that it may nevertheless be time to recommend a ‘preventive’ diet, particularly as this is likely to have other health benefits.

“Despite the absence of gold standard interventional data demonstrating a benefit of dietary interventions in preventing disease, in my opinion, it may still be reasonable to suggest such interventions to motivated individuals that incorporate several of the dietary patterns associated with lower risk of IBD from this and other studies.

“This includes ensuring adequate dietary fibre, particularly from fruit and vegetables, intake of fish, minimising sugar-sweetened beverages and preferring fresh over processed and ultra-processed foods and snacks.”

31/01/2024 

Notes for editors
Research: Early-life diet and risk of inflammatory bowel disease: a pooled study in two Scandinavian birth cohorts doi 10.1136/gutjnl-2023-330971
Editorial: Inflammatory Bowel Diseases: Are we ready to recommend a preventive diet for infants? Doi 10.1136/gutjnl-2024-331849

Funding: Barndiabetesfonden (Swedish Child Diabetes Foundation); Swedish Council for Working Life and Social Research; Swedish Research Council; Medical Research Council of Southeast Sweden; Henning and Johan Throne-Holst Foundation

Link to Academy of Medical Sciences labelling system
http://press.psprings.co.uk/AMSlabels.pdf 

Externally peer reviewed? Yes (research); No (Editorial)
Evidence type: Observational; Opinion
Subjects: People

The post High quality diet in early life may curb subsequent inflammatory bowel disease risk first appeared on BMJ Group.

Constipation, difficulty swallowing, irritable bowel syndrome (IBS) among them

Certain gut problems, such as constipation, difficulty swallowing, and irritable bowel syndrome (IBS), may be early warning signs of the neurological condition Parkinson’s disease, suggests research published online in the journal Gut.

Gastrointestinal symptoms are thought to precede the development of cerebrovascular disease, such as stroke or a brain aneurysm, or Alzheimer’s disease, and it has been suggested (Braak’s hypothesis) that gut conditions may precede the development of Parkinson’s disease too.

To test this hypothesis, the researchers used data from a US nationwide medical record network (TriNetX) to compare 24, 624 people who had been diagnosed with Parkinson’s disease of unknown cause with those who had been diagnosed with other neurological conditions—Alzheimer’s disease (19,046) or cerebrovascular disease (23,942)—or with none of these (24,624; comparison group). 

Those with Parkinson’s disease were matched with people in the other groups for age, sex, race and ethnicity, and length of diagnosis to compare the frequency of gut conditions included in their electronic health record for an average of 6 years before their Parkinson’s disease diagnosis.

The researchers then tested the same hypothesis, but in a different way, by dividing all the adults in the network who had been diagnosed with any of 18 gut conditions into separate groups—one for each condition of interest. 

People in these groups were matched with people without the particular gut condition and monitored via their medical records for 5 years to see how many of them developed Parkinson’s disease or other neurological disorders. 

Both analyses indicated that 4 gut conditions were associated with a higher risk of a Parkinson’s disease diagnosis. 

Specifically, gastroparesis (delayed stomach emptying), dysphagia (difficulty swallowing), and constipation were all associated with a more than doubling in risk of Parkinson’s disease in the 5 years preceding the diagnosis, while IBS without diarrhoea was associated with a 17% higher risk. 

Appendix removal, however, seemed to be protective, prompting questions about its potential role in the disease processes leading to Parkinson’s disease, say the researchers. 

Neither inflammatory bowel disease nor vagotomy (removal of all or part of the vagus nerve to treat peptic ulcer) were associated with a heightened risk.

Some other gut issues, including functional dyspepsia (burning sensation or fullness of the stomach with no obvious cause); IBS with diarrhoea; and diarrhoea plus faecal incontinence, were also more prevalent among people who developed Parkinson’s disease. 

But these conditions were also more prevalent before the onset of Alzheimer’s disease or cerebrovascular disease.

This is an observational study, and as such, can’t establish cause. The researchers also highlight several limitations to their findings, including that the monitoring period was relatively short and that the diagnostic information captured in electronic health records might have been incomplete.

Nevertheless, they conclude: “This study is the first to establish substantial observational evidence that the clinical diagnosis of not only constipation, but also dysphagia, gastroparesis and irritable bowel syndrome without diarrhoea might specifically predict the development of Parkinson’s disease.”

They add: “These findings warrant alertness for [gastrointestinal] syndromes in patients at higher risk for Parkinson’s disease and highlight the need for further investigation of [gastrointestinal] precedents in Alzheimer’s disease and cerebrovascular disease.”

24/08/2023

Notes for editors
Research: Gastrointestinal syndromes preceding a diagnosis of Parkinson’s disease: testing Braak’s hypothesis using a nationwide database for comparison with Alzheimer’s disease and cerebrovascular diseases doi 10.1136/gutjnl-2023-329685
Journal: Gut

Funding: None declared

Link to Academy of Medical Sciences labelling system
http://press.psprings.co.uk/AMSlabels.pdf 

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: People

The post Certain gut conditions may be early warning signs of Parkinson’s disease first appeared on BMJ Group.

Risk cumulative, and greatest 1-2 years after use and for antibiotics targeting gut infections

Frequent use of antibiotics may heighten the risk of inflammatory bowel disease—Crohn’s disease and ulcerative colitis—among the over 40s, suggests research published online in the journal Gut.

The risk seems to be cumulative and greatest 1-2 years after use and for those antibiotics targeting gut infections, the findings indicate.

Mounting evidence suggests that environmental factors are likely implicated in the development of inflammatory bowel disease (IBD). Globally, close to 7 million people have the condition, with this number expected to rise over the next decade, say the researchers.

One factor associated with IBD risk in younger people is the use of antibiotics, but it’s not clear if this association might also apply in older people.

To explore this further, the researchers drew on national medical data from 2000 to 2018 for Danish citizens aged 10 upwards who hadn’t been diagnosed with IBD.

They specifically wanted to know if the timing and dose of antibiotic might be important for the development of IBD, and whether this varied by IBD and antibiotic type.

More than 6.1 million people were included in the study, just over half of whom were female. In total, 5.5 million (91%) were prescribed at least one course of antibiotics between 2000 and 2018. 

During this period, some 36,017 new cases of ulcerative colitis and 16,881 new cases of Crohn’s disease were diagnosed.

Overall, compared with no antibiotic use, use of these drugs was associated with a higher risk of developing IBD, regardless of age. But older age was associated with the highest risk.

Those aged 10-40 were 28% more likely to be diagnosed with IBD; 40- 60 year olds were 48% more likely to do so, while the over 60s  were 47% more likely to do so.

The risks were slightly higher for Crohn’s disease than they were for ulcerative colitis: 40% among 10-40 year olds; 62% among 40-60 year olds; and 51% among the over 60s.

The risk seemed to be cumulative, with each subsequent course adding an additional 11%, 15%, and 14% heightened risk, according to age band. 

The highest risk of all was observed among those prescribed 5 or more courses of antibiotics: 69% heightened risk for 10–40 year olds; a doubling in risk for 40–60 year olds; and a 95% heightened risk for the over 60s.

Timing also seemed to be influential, with the highest risk for IBD occurring 1–2 years after antibiotic exposure, with each subsequent year thereafter associated with a lowering in risk.

Specifically, among 10–40 year olds IBD risk was 40% higher 1–2 years after taking antibiotics compared with 13% 4–5 years later. The equivalent figures for 40–60 year olds were 66% vs 21% and for the over 60s 63% vs 22%. 

As to antibiotic type, the highest risk of IBD was associated with the nitroimidazoles and fluoroquinolones, which are usually used to treat gut infections. These are known as broad spectrum antibiotics because they indiscriminately target all microbes, not just those that cause disease.

Nitrofurantoin was the only antibiotic type not associated with IBD risk at any age. 

Narrow spectrum penicillins were also associated with IBD, although to a much lesser extent. This adds weight to the notion that changes in the gut microbiome may have a key role and that many antibiotics have the potential to alter the make-up of microbes in the gut.

This is an observational study, and as such, can’t establish cause. Nor was information available on what the drugs were for or how many of them patients actually took, note the researchers.

But there are some plausible biological explanations for the findings, they suggest, highlighting the natural diminution of both the resilience and range of microbes in the gut microbiome associated with aging, which antibiotic use is likely to compound.

“Furthermore, with repeated courses of antibiotics, these shifts can become more pronounced, ultimately limiting recovery of the intestinal microbiota,” they add.

Limiting prescriptions for antibiotics may not only help to curb antibiotic resistance but may also help lower the risk of IBD, they venture.

“The association between antibiotic exposure and the development of IBD underscores the importance of antibiotic stewardship as a public health measure, and suggests the gastrointestinal microbiome as an important factor in the development of IBD, particularly among older adults,” they conclude.

9/1/23

Notes for editors 

Research: Antibiotic use as a risk factor for inflammatory bowel disease across the ages: a population-based cohort study doi 10.1136/gutjnl-2022-327845

Journal: Gut

Funding: None declared

Link to Academy of Medical Sciences labelling system

http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: People

The post Frequent use of antibiotics may heighten inflammatory bowel disease risk in over 40s first appeared on BMJ Group.

Effects felt within 1-2 days; clinical trial of those who don’t require hospital admission warranted

A widely available and inexpensive drug that is used to ease the symptoms of indigestion may prove a worthy contender for treating COVID-19 infection in those whose disease doesn’t require admission to hospital, suggest the findings of a small case series, published online in the journal Gut.

The effects were felt within 24 to 48 hours of taking famotidine, and a rigorous clinical trial is now warranted to see if the drug could be an effective treatment for COVID-19, say the researchers.

Famotidine (Pepcid AC) belongs to a class of drugs known as histamine-2 receptor antagonists, which reduce the amount of stomach acid produced. Famotidine can be taken in doses of 20-160 mg, up to four times a day, for the treatment of acid reflux and heartburn.

The researchers report on 10 people (6 men; 4 women) who developed COVID-19 infection, all of whom happened to have been taking famotidine during their illness.

The severity of five cardinal symptoms–cough; shortness of breath; fatigue; headache and loss of taste/smell as well as general unwellness–was measured using a version of a 4-point scale normally applied to assess the severity of cancer symptoms (ECOG PS).

Seven of the patients tested positive for COVID-19, using a swab test; two had antibodies to the infection; and one patient wasn’t tested but was diagnosed with the infection by a doctor.

Their ages ranged from 23 to 71 and they had a diverse range of ethnic backgrounds and known risk factors for COVID-19 severity, including high blood pressure and obesity. 

All started taking famotidine when they were feeling very poorly with COVID-19, the symptoms of which had been going on from 2 up to 26 days at that point. 

The most frequently used dose was 80 mg taken three times a day, with the average treatment period lasting 11 days, but ranging from 5 to 21 days.

All 10 patients said that symptoms quickly improved within 24-48 hours of starting famotidine and had mostly cleared up after 14 days. 

Improvement was evident across all symptom categories assessed, but respiratory symptoms, such as cough and shortness of breath, improved more rapidly than systemic symptoms, such as fatigue.

Seven of the patients didn’t experience any side effects while on famotidine, and in the three who did, these were mild, and all but temporary forgetfulness were known side effects associated with taking the drug.

While promising, the researchers point out that the findings might have been affected by ‘the placebo effect,’ and/or hazy recall, added to which the number of case study participants was small.

“Our case series suggests, but does not establish, a benefit from famotidine treatment in outpatients with COVID-19,” they caution.  And it’s not clear how famotidine might work: if it might incapacitate the virus in some way or alter a person’s immune response to it.

“Clinically, we unreservedly share the opinion that well designed and informative studies of efficacy are required to evaluate candidate medications for COVID-19 as for other diseases,” they emphasise.

Nevertheless, they suggest their findings warrant further more detailed study, adding that a clinical trial, testing the combination of famotidine with the antimalarial drug hydroxychloroquine in patients admitted to hospital with COVID-19, is already under way.

“An outpatient study of oral famotidine that investigates efficacy for symptom control, viral burden and disease outcome and assesses the effects of medication use on long term immunity should be considered to establish if famotidine may be of use in controlling COVID-19 in individual patients while also reducing the risk of SARS-CoV-2 transmission,” they conclude.

[Ends]

04/06/2020

Notes for editors
Research: Famotidine use and quantitative symptom tracking for COVID-19 in non-hospitalised patients: a case series doi 10.1136/gutjnl-2020-321852
Journal: Gut

Funding: National Institutes for Health

Link to Academy of Medical Sciences labelling system
http://press.psprings.co.uk/AMSlabels.pdf

Peer reviewed? Yes
Evidence type: Case series
Subjects: People

Link to article
https://gut.bmj.com/lookup/doi/10.1136/gutjnl-2020-321852

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