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Association between Early Childhood Otitis Media and Pediatric Inflammatory Bowel Disease: An Exploratory Population-Based Analysis

  • Souradet Y. Shaw
    Affiliations
    Inflammatory Bowel Disease Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada

    Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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  • James F. Blanchard
    Affiliations
    Inflammatory Bowel Disease Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada

    Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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  • Charles N. Bernstein
    Correspondence
    Reprint requests: Charles N. Bernstein, MD, University of Manitoba, 804F-715 McDermot Avenue, Winnipeg, MB, Canada R3E3P4.
    Affiliations
    Inflammatory Bowel Disease Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada

    Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Published:October 19, 2012DOI:https://doi.org/10.1016/j.jpeds.2012.08.037

      Objective

      To determine whether a diagnosis of otitis media in the first 5 years of childhood is associated with the development of pediatric inflammatory bowel disease (IBD).

      Study design

      This was a nested case-control analysis of a population-based IBD database in Manitoba, Canada. A total of 294 children with IBD diagnosed between 1989 and 2008 were matched to 2377 controls, based on age, sex, and geographic region. The diagnosis of ottis media was based on physician claims. IBD status was determined based on a validated administrative database definition. Multivariate conditional logistic regression models were used to model the association between otitis media and IBD, adjusted for annual physician visits.

      Results

      Approximately 5% of the IBD cases and 12% of the controls did not have an otitis media diagnosis before that IBD case date. By age 5 years, 89% of the IBD cases had at least one diagnosis of otitis media, compared with 82% of the controls. In multivariate analyses, compared with cases and controls without an otitis media diagnosis, individuals with an otitis media diagnosis by age 5 years were 2.8-fold more likely to be an IBD case (95% CI, 1.5-5.2; P = .001). This association was detected in stratified models examining Crohn's disease and ulcerative colitis separately.

      Conclusion

      Compared with controls, subjects diagnosed with IBD were more likely to have had at least one early childhood episode of otitis media before their diagnosis. We suspect that otitis media serves as a proxy measure of antibiotic use.
      CD (Crohn's disease), FY (Fiscal year), IBD (Inflammatory bowel disease), ICD (International Classification of Diseases and Related Health Problems), ICD-9-CM (International Classification of Diseases and Related Health Problems, Ninth Revision, Clinical Modification), UC (Ulcerative colitis), UMIBDED (University of Manitoba Inflammatory Bowel Disease Epidemiology Database)
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      References

        • Bernstein C.N.
        • Blanchard J.F.
        Epidemiology of inflammatory bowel disease.
        in: Cohen R.D. Inflammatory bowel disease: diagnosis and therapeutics. Humana Press, Totowa, NJ2003: 17-32
        • Podolsky D.K.
        Inflammatory bowel disease.
        N Engl J Med. 2005; 358: 1965-1968
        • Loftus Jr., E.V.
        • Sandborn W.J.
        Epidemiology of inflammatory bowel disease.
        Gastroenterol Clin North Am. 2002; 31: 1-20
        • Crohn's and Colitis Foundation of Canada
        The burden of inflammatory bowel disease (IBD) in Canada.
        Crohn's and Colitis Foundation of Canada, Toronto2008
        • Dethlefsen L.
        • Huse S.
        • Sogin M.L.
        • Relman D.A.
        The pervasive effects of an antibiotic on the human gut microbiota, as revealed by deep 16S rRNA sequencing.
        PLoS Biol. 2008; 6: e280
        • Jernberg C.
        • Lofmark S.
        • Edlund C.
        • Jansson J.K.
        Long-term ecological impacts of antibiotic administration on the human intestinal microbiota.
        ISME J. 2007; 1: 56-66
        • Sullivan A.
        • Edlund C.
        • Nord C.E.
        Effect of antimicrobial agents on the ecological balance of human microflora.
        Lancet Infect Dis. 2001; 1: 101-114
        • Card T.
        • Logan R.F.A.
        • Rodrigues L.C.
        • Wheeler J.G.
        Antibiotic use and the development of Crohn's disease.
        Gut. 2004; 53: 246-250
        • Hildebrand H.
        • Malmborg P.
        • Askling J.
        • Ekbom A.
        • Montgomery S.M.
        Early-life exposures associated with antibiotic use and risk of subsequent Crohn's disease.
        Scand J Gastroenterol. 2008; 43: 961-966
        • Gilat T.
        • Hacohen D.
        • Lilos P.
        • Langman M.J.
        Childhood factors in ulcerative colitis and Crohn's disease: an international cooperative study.
        Scand J Gastroenterol. 1987; 22: 1009-1024
        • Wurzelmann J.I.
        • Lyles C.M.
        • Sandler R.S.
        Childhood infections and the risk of inflammatory bowel disease.
        Dig Dis Sci. 1994; 39: 555-560
        • Shaw S.Y.
        • Blanchard J.F.
        • Bernstein C.N.
        Association between the use of antibiotics in the first year of life and pediatric inflammatory bowel disease.
        Am J Gastroenterol. 2010; 105: 2687-2692
        • Shaw S.Y.
        • Blanchard J.F.
        • Bernstein C.N.
        Association between the use of antibiotics and new diagnoses of Crohn's disease and ulcerative colitis.
        Am J Gastroenterol. 2011; 106: 2133-2142
        • Dietert R.R.
        • Zelikoff J.T.
        Identifying patterns of immune-related disease: use in disease prevention and management.
        World J Pediatr. 2010; 6: 111-118
        • Watson D.E.
        • Katz A.
        • Reid R.J.
        • Bogdanovic B.
        • Roos N.
        • Heppner P.
        Family physician workloads and access to care in Winnipeg: 1991 to 2001.
        CMAJ. 2004; 171: 339-342
        • Bernstein C.N.
        • Blanchard J.F.
        • Rawsthorne P.
        • Wajda A.
        Epidemiology of Crohn's disease and ulcerative colitis in a central Canadian province: a population-based study.
        Am J Epidemiol. 1999; 149: 916-924
        • Long J.S.
        • Freese J.
        Regression models for categorical dependent variables using Stata.
        StataCorp, College Station, TX2006
        • Hviid A.
        • Svanstrom H.
        • Frisch M.
        Antibiotic use and inflammatory bowel diseases in childhood.
        Gut. 2011; 60: 49-54
        • Margolis D.J.
        • Fanelli M.
        • Hoffstad O.
        • Lewis J.D.
        Potential association between the oral tetracycline class of antimicrobials used to treat acne and inflammatory bowel disease.
        Am J Gastroenterol. 2010; 105: 2610-2616
        • Rovers M.M.
        • Glasziou P.
        • Appelman C.L.
        • Burke P.
        • McCormick D.P.
        • Damoiseaux R.A.
        • et al.
        Antibiotics for acute otitis media: a meta-analysis with individual patient data.
        Lancet. 2006; 368: 1429-1435
        • Gupta N.
        • Bostrom A.G.
        • Kirschner B.S.
        • Ferry G.D.
        • Winter H.S.
        • Baldassano R.N.
        • et al.
        Gender differences in presentation and course of disease in pediatric patients with Crohn disease.
        Pediatrics. 2007; 120: e1418-e1425
        • Benchimol E.I.
        • Fortinsky K.J.
        • Gozdyra P.
        • Van den Heuvel M.
        • Van Limbergen J.
        • Griffiths A.M.
        Epidemiology of pediatric inflammatory bowel disease: a systematic review of international trends.
        Inflamm Bowel Dis. 2011; 17: 423-439