Meta-analysis associates childhood antibiotic use with increased inflammatory bowel disease risk

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Inflammatory bowel diseases Published May 4, 2026 Medically reviewed May 8, 2026 Study authors: Størdal Ketil, Andersen Svend, Mårild Karl, Larsson Vilhelm, Imberg Henrik PubMed ↗ DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Note the association between childhood antibiotic use and increased risk of Crohn's disease and ulcerative colitis.

This meta-analysis synthesized data from 8 studies involving 2783 cases to evaluate the relationship between antibiotic exposure in children, aged 1 to 17 years, and the development of inflammatory bowel disease (IBD). The analysis specifically looked at the risks associated with Crohn's disease and ulcerative colitis.

The pooled results indicated an increased risk of IBD with a relative risk (RR) of 1.42 (95% CI, 1.23-1.66). When examining specific conditions, the risk for Crohn's disease was increased with an RR of 1.59 (95% CI, 1.39-1.81). Similarly, the risk for ulcerative colitis was increased with an RR of 1.23 (95% CI, 1.08-1.40).

While these associations were identified, the authors note that a causal interpretation should be cautious. The meta-analysis does not provide details on follow-up duration or specific antibiotic types used.

For clinicians, these data suggest that childhood antibiotic exposure is associated with an increased risk of later IBD, particularly for Crohn's disease. These findings may assist in risk stratification, though the observed associations do not establish direct causation.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

PMID41617205

View Original Abstract ↓

BACKGROUND: Antibiotic use in early childhood may alter the developing microbiome and has been proposed as a risk factor for inflammatory bowel disease (IBD). We conducted a systematic review to examine the association between childhood antibiotic use and subsequent risk of IBD. METHODS: In a systematic literature search, we identified cohort and case-control studies reporting the association between antibiotic use (exposure age <1 to 17 years) and development of IBD. MEDLINE and EMBASE databases were searched from inception through December 31, 2024. Studies reporting a hazard ratio, odds ratio, or risk ratio (RR) were included. To account for heterogeneity, pooled estimates were calculated using the DerSimonian-Laird random-effects model. Estimates were adjusted for potential confounding as reported in the original studies. RESULTS: We identified 10 studies, of which 8 (n = 2783 cases) reported associations between childhood antibiotics and IBD risk. Additionally, 2 studies on Crohn's disease (CD) and 1 on ulcerative colitis were included in disease-specific analyses. In pooled analyses, antibiotic exposure compared with no exposure was associated with increased risk of IBD (RR, 1.42; 95% confidence interval [CI], 1.23-1.66), CD (RR, 1.59; 95% CI, 1.39-1.81), and ulcerative colitis (RR, 1.23; 95% CI, 1.08-1.40). Heterogeneity was low to moderate (I2 = 0%-35%), and funnel plots did not indicate publication bias (Egger's test, P = .12-.43). Adjustment for infections did not attenuate the association between childhood antibiotic exposure and IBD development. CONCLUSIONS: While causal interpretation should be cautious, childhood exposure to antibiotics was associated with an increased risk of later IBD, particularly for CD.