CoChat
Sign Up
Cited by 181Inflammatory Bowel DiseaseOcular Diseases and Behçet’s SyndromeMicroscopic Colitis

Do NSAIDs, Antibiotics, Infections, or Stress Trigger Flares in IBD?

Singh, Sunny, Graff, Lesley A, Bernstein, Charles N·2009·The American Journal of Gastroenterology
DOI 10.1038/ajg.2009.15
Open this paper in CoChat — free account

Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics, enteric or other systemic infections, and stress have all been reported to be potential triggers of inflammatory bowel disease (IBD). Although a mechanism of triggering a flare of IBD can be hypothesized for each factor, the associations of these factors with flares of IBD remains confusing. In this review, we analyze the literature that explores these associations. There is some evidence to support an association between NSAID use and flares but little data to associate antibiotic use directly with flares. An important connection between antibiotic use and an exacerbation of symptoms is through the development of Clostridium difficile infections. However, for all enteric infections, including C. difficile, it is unclear whether these infections simply trigger symptoms in patients with IBD that resolve on resolution of the infection, or whether they truly trigger a flare of intestinal inflammation that outlasts the infection. There is a paucity of evidence that other systemic infections trigger flares of IBD. Although there is strong evidence for an association between perceived stress levels and flares, there is a weaker association between a simple accounting of stressful life events and flares. Much of the literature is limited by a lack of adequate control groups and failure to report on base rates in the population under study (i.e., NSAIDs and antibiotic use, occurrence of infections, and stress levels). More large population-based matched cohort or case crossover studies and a continued emphasis on prospective designs are needed to better explore these potential associations. Clinical implications given the current state of knowledge are discussed.

Integrity signals

Registry

Crossref · 10.1038/ajg.2009.15

Cites

100 of 100 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • IBD patients are particularly susceptible to the development of bacterial superinfections, especially those caused by Clostridium difficile, Campylobacter, Salmonella, Shigella and Entamoeba histolytica, which represent harmful stimuli that can induce a relapse of the disease in a microenvironment that is already altered.

    “This is likely because IBD patients are particularly susceptible to the development of bacterial superinfections, especially those caused by Clostridium difficile, Campylobacter, Salmonella, Shigella and Entamoeba histolytica, which represent harmful stimuli that can induce a relapse of the disease in a microenvironment that is already altered[140,141].”

    From Proton pump inhibitors and dysbiosis: current knowledge and aspects to be clarified (2019) · cites this paper as [141]

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Singh, S., Graff, L. A., & Bernstein, C. N.
Affiliations
University of Manitoba (CA)
ORCID
Venue
The American Journal of Gastroenterology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2009-03-31
Volume
104
Issue
5
Pages
1298-1313
ISSN
  • 0002-9270 (ISSN-L)
  • 1572-0241
DOI
10.1038/ajg.2009.15
OpenAlex
W1983233325
Cited by
181
References
100
Citations by year
2026: 2 · 2025: 7 · 2024: 7 · 2023: 7 · 2022: 10 · 2021: 7 · 2020: 14 · 2019: 14 · 2018: 5 · 2017: 10 · 2016: 10 · 2015: 12 · 2014: 20 · 2013: 11 · 2012: 8
FWCI
1.41
Type
journal article
Language
en
Open access
closed
Licence
www.springer.com/tdm (unspecified)
Locations
  • The American Journal of Gastroenterology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
  • Health Sciences › Medicine › Ophthalmology › Ocular Diseases and Behçet’s Syndrome
  • Health Sciences › Medicine › Epidemiology › Microscopic Colitis
Keywords
inflammatory bowel disease, disease flares, NSAID use, antibiotic use, Clostridium difficile infection, gastrointestinal infections, systemic infection, stress, life events
MeSH terms
Anti-Inflammatory Agents, Non-Steroidal, Anti-Bacterial Agents, Bacterial Infections, Education, Medical, Continuing, Female, Gastrointestinal Diseases, Humans, Male, Prognosis, Recurrence, Sensitivity and Specificity, Stress, Psychological, Inflammatory Bowel Diseases, Incidence, Risk Assessment

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review