P856 Associations of antibiotics, hormonal therapies, oral contraceptives, and long-term NSAIDs with Inflammatory Bowel Disease: results from the Prospective Urban Rural Epidemiology (PURE) study

Narula, N.(1)*;Wong, E.C.L.(2);Pray, C.(2);Marshall, J.K.(2);Rangarajan, S.(3);Islam, S.(3);Bahonar, A.(4);Alhabib, K.F.(5);Kontsevaya, A.(6);Ariffin, F.(7);Co, H.U.(8);Al Sharief, W.(9);Szuba, A.(10);Wielgosz, A.(11);Diaz, M.L.(12);Yusuf, R.(13);Kruger, L.(14);Soman, B.(15);Li, Y.(16);Wang, C.(16);Yin, L.(16);Erkin, M.(17);Lanas, F.(18);Davletov, K.(19);Rosengren, A.(20);Lopez-Jaramillo, P.(21);Khatib, R.(22);Oguz, A.(23);Iqbal, R.(24);Yeates, K.(25);Avezum, Á.(26);Reinisch, W.(27);Moayyedi, P.(1);Yusuf, S.(3);

(1)McMaster University and Hamilton Health Sciences, Department of Medicine Division of Gastroenterology and Farncombe Family Digestive Health Research Institute- Population Health Research Institute, Hamilton, Canada;(2)McMaster University, Department of Medicine Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, Hamilton, Canada;(3)McMaster University and Hamilton Health Sciences, Population Health Research Institute, Hamilton, Canada;(4)Isfahan University of Medical Sciences, Isfahan Cardiovascular Research Center- Cardiovascular Research Institute, Isfahan, Iran- Islamic Republic Of;(5)King Saud University, Department of Cardiac Sciences- King Fahad Cardiac Center- College of Medicine, Riyadh, Saudi Arabia;(6)Russian Federation, National research center for therapy and preventive medicine, Moscow, Russian Federation;(7)Faculty of Medicine UiTM, Primary Care Medicine, Sungai Buloh, Malaysia;(8)University of the Philippines College of Medicine, Department of Medicine, Manila, Philippines;(9)Medical Education & Research Department in Dubai Health Authority, Family Medicine Department, Dubai, United Arab Emirates;(10)Wroclaw Medical University, Department of Angiology- Hypertension and Diabetology, Wroclaw, Poland;(11)University of Ottawa, This email address is being protected from spambots. You need JavaScript enabled to view it., Ottawa, Canada;(12)ECLA, Cardiology, Santa Fe, Argentina;(13)Independent University, Medicine, Bashundhara, Bangladesh;(14)North-West University, Africa Unit for Transdisciplinary Health Research AUTHeR, Potchefstroom, South Africa;(15)Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India;(16)Peking Union Medical College & Chinese Academy of Medical Sciences, Medical Research & Biometrics Center- National Clinical Research Center for Cardiovascular Diseases,Fuwai Hospital- National Center for Cardiovascular Diseases, Beijing, China;(17)Kyrgyz State Medical Academy, Medicine, Bishkek, Kyrgyz Republic;(18)Universidad de La Frontera, Medicine, Temuco, Chile;(19)Al-Farabi Kazakh National University, Health Research Institute, Almaty, Kazakhstan;(20)University of Gothenburg and Sahlgrenska University Hospital, Sahlgrenska Academy, Region Västra Götaland, Sweden;(21)Universidad de Santander UDES, Masira Research Institute, Bucaramanga, Colombia;(22)Birzeit University, Institute of Community and Public Health, Birzeit, Palestine;(23)Istanbul Medeniyet University, Faculty of Medicine- Department of Internal Medicine, Istanbul, Turkey;(24)Aga Khan University, Department of Community Health Sciences, Karachi City, Pakistan;(25)Queen's University, Department of Medicine, Kingston, Canada;(26)Hospital Alemão Oswaldo Cruz, International Research Center, São Paulo, Brazil;(27)Medical University of Vienna, Department of Internal Medicine III- Division of Gastroenterology and Hepatology, Vienna, Austria;


Several medications have been considered to contribute to the aetiology of inflammatory bowel disease (IBD).  This study assessed the association between medication use and risk of developing IBD using the Prospective Urban Rural Epidemiology (PURE) cohort.


This was a prospective cohort study of 133,137 individuals between the ages of 20-80 from 24 countries. Country-specific validated questionnaires documented baseline and follow-up medication use. Participants were followed prospectively at least every 3 years. The main outcome was development of IBD, including Crohn’s disease (CD) and ulcerative colitis (UC). Short-term (baseline but not follow-up use) and long-term use (baseline and subsequent follow-up use) was evaluated.  Results are presented as adjusted odds ratios (aOR) with 95% confidence intervals (CI).


During the median follow-up of 11.0 years [interquartile range (IQR) 9.2-12.2], we recorded 571 incident cases of IBD (143 CD and 428 UC).   Higher risk of incident IBD was associated with baseline antibiotic use [aOR: 2.81 (95% CI: 1.67-4.73), p=0.0001] and hormonal medication use [aOR: 4.43 (95% CI: 1.78-11.01), p=0.001]. Among females, previous or current oral contraceptive use was also associated with IBD development [aOR: 2.17 (95% CI: 1.70-2.77), p=5.02E-10]. NSAID users were also observed to have increased risk of IBD [aOR: 1.80 (95% CI: 1.23-2.64), p=0.002], which was driven by long-term users [aOR: 5.58 (95% CI: 2.26-13.80), p<0.001]. All significant results were consistent in direction for CD and UC with low heterogeneity.


Antibiotics, hormonal medications, oral contraceptives, and long-term NSAID use were associated with increased odds of incident IBD after adjustment for covariates.