Can antibiotics cause Crohn's disease?

Hi Everyone,

As you all know from my previous posts, I have been dealing with intestinal issues now for the past year( just gotten way worse in the last 6 months). Anyhow, I have seen my GI several time and he keeps saying IBS. He has only done blood work and stool tests. He did not want to put me though a colonoscopy as he did not think the benefit outweighed the risk in my case.

I have been chronically ill with different issues for years. I have IC, Fibro, Chronic UTI's that have been controlled with being on low dose prophlaxis antibitoics daily), Grade 1 heart murmur, eczema( since I was little), possible undifferenciated connective tissue disease, etc.. My life has been hell for the last 9 years basically.

Anyhow, I have been on a low dose antibitoic( keflex) for over 4 years now due to my frequent UTI's I get. When you have IC(interstitial cystitis) you are more prone to infections from what the uro doc told me. Mind you, I also have been taking high doses of probitoics daily for years as well. '

My intetsinal issues started shortly after I had a stomach flu a year ago. It started like I would get pain that would come and go. Then about 6 months ago the bottom seemed to fall out and I was having more and more bad days. My symptoms are mainly crampy, sore pain all througout my upper and lower intestines. I do not have diareha per say, though my stools will be lose when I have my period. My normal use to be having a BM once a day. Now I will go once every other day or two days. I have tried to alter my diet and I cannot find a happy place. I also notice the last two days my stools are more narrow and I have to push to get them out. It seems like that urge you get when yo gotta go , well I get the urge but then it disappears quickly. Then I end up having to push to get my BM out.

My GI knows my history and he still is sure this is all IBS. He is not test happy like alot of doctors that like to push procedures. He thinks invasive tests should only be done as a last resort. I have been reading that there is a connection between antibitoics and crohns disease and that antibitoics have been linked to causing this illness. My GI doc says there is no real proof behind that , that there are alot of people who take antibitoics even prophlaxis low dose and they never get crohn's.

I can see where a person can get it though, especially if it is bacteria in nature since antibitoics kill bacteria which leave us suseptible to issues. I however have been on heavy duty probitocs for years as well to prevent any issues. I am now wondering if probitoics can cause crohns even since they are bacteria as well. What are your thoughts on this????

I doubt the probiotics would cause Crohn's. I haven't heard that mentioned anywhere ever. Antibiotics I have heard possibly causing Crohn's along with many other drugs. One of the main things is having a genetic disposition to having it. So antibiotics and Advil etc are known as possible triggers for something that may have been living dormant. Just because other people don't get Crohn's doesn't mean it isn't possible.

Honestly I don't like the sound of your GI. There are other tests that aren't invasive that you might be able to do like a MRI for example or a small bowel series/barium swallow with x-ray. If it were me, I'd want to see someone else. Have you gone for a second opinion? Sometimes people have to try out multiple GI doctors until they find one that will take them seriously.

Did those stool tests involve one that tests for inflammation? I forget the name of the test exactly but your GI should know what it is and if not I know that David know's the name of it. Also did they check your CRP level in the blood work? Do you know what it was? With IBS only microscopic inflammation can be found. If your numbers are high, then that's not microscopic.

Probiotics are common strains already found in the intestine, I doubt they cause crohn, some might not be very helpful. We have gazillions of bacteria in our intestine, if our body started attacking common bacteria with macrophages we would be fucked, we wouldn't make it through a single day, that isn't happening. There's a few labs that do tests on mice with species that are easy to induce collitis in and other gastro disease, and they use probiotics, if they saw a negative effect I think they would have pulled on the alarm bell by now.

antibiotics

http://www.ncbi.nlm.nih.gov/pubmed/20966024

http://www.ncbi.nlm.nih.gov/pubmed/21912437

Once you already have crohn I don't think it matters one bit though.

Crabby said:

Did those stool tests involve one that tests for inflammation? I forget the name of the test exactly but your GI should know what it is and if not I know that David know's the name of it. Also did they check your CRP level in the blood work? Do you know what it was? With IBS only microscopic inflammation can be found. If your numbers are high, then that's not microscopic.

Click to expand...

I'm guessing you're thinking of [wiki]fecal lactoferrin[/wiki] or [wiki]fecal calprotectin[/wiki]. And I agree with you, I think that they're tests that everyone should demand if their doctor is trying to say IBS and you suspect it's something more.

And with IBS, no inflammation should be found otherwise it's IBD of some sort or acute/infectious/some chronic disease I don't know about in nature.

Hey Crabby,

Thanks for the reply. He did a stool test, not sure if it was for inflammation or not.I know it checked for parasites and c-diff and blood. I am interested in this inflammation stool test though for sure. He did do blood work, he checked my sed rate and it was normal. Do not think he checked my c-reactive protein though.

Note: I have to say that I have had my C-reactive protein and sed rates done in the past and they were both elevated alot of the times( though I was not having any GI issues at that time in my life)I was having other health issues (interstitial cystitis, fibro, etc..). I was told I likely had some sort of autoimmune issue. I am not sure what is considered high, but none of my doctors including the rheumy I had seen seemed comcerned about the elevated rates at that time. For instance back in 2010 I had a sed rate done and it was at 37. I also had my C-reactive protein done by a rheumy about a year ago and it was elevated. Cannot remember how high, but the rheumy did not seem overly concerned about it. Mine have went up and down for the last 9 years. I am not sure what is considered high. But the sed rate that was just recently done by my GI doc(3 months ago) while I was having symtpoms came back normal, so I do not know what to think about that.

I was told that the C-reactive protein and sed rates can be elevated even when you have a simple cold or virus. In crohn's would this elevation be very high??? I also had my B12 checked and it was normal as well as the rest of my comprehensive blood work( cbc, and all that)

I Dont think this GI doc is bad per say, I think he is just cautious and does not want to put me thorugh anymore issues if it can be avoided. I however would be interested in some of the tests you mentioned, at least ones that do not involve laxatives that wipe out the good gut flora. Which tests could I take that can help rule out crohn's that do not involve disrupting my gut flora. You see I am already on a low dose antibitoic( have been for over 4 years) which I know is not the best thing as it does wipe out flora, the last thing I want to do is wipe out anymore. I do take probitoics daily, have been for years. What is the name of this stool test that checks for inflammation?? How would they be able to tell if your intestines are inflammed through a stool test?? I am interested. I know when I see my GI doc at the end of this month, if I ask him to do some of these tests you mentioned, I am sure he will. I think he is just cautious. He even told me that alot of doctors push tests right away, even when they are not needed. He is suppose to be a very good GI doc, he is the chief of gastroenterology at one of the best hospitals here in Chicago. But I see where you are coming from too, I mean I think there is a such thing as being to reserved as well.

I just do not understand why he is sure I have IBS. Is there something or some symptom that differenciates crohn's from IBS?

In Africa they use antibiotics by the buckets btw, to treat TB and HIV, and none of them are developing crohn's disease.

Hi David,

Thanks for that info on the stool test that checks for inflammation. I recently had my sed rate checked and it was normal as well as my blood work. My B12 was also normal.

Here is the thing, I have had my sed rate and C-reactive proteins checked for the last 9 years and they have been elevated on and off. This was before I even had any intestinal issues though. I deal with other health issues like Interstitial cystits, chroinc UTI's( though have been kept at bay with low dose antibitoic). I even had a positive ANA years back. It has went back to normal since then though. I was also told that sed rates and C-reactive proteins can be elevated for even a slight thing like a cold or virus. I assuming when they check these levels to check for crohns, are they highly elevated with this disease? For instance, when my sed rate was checked back a year and half ago when I was not having any gut issues, it was at 37. This was considered elevated, but the rheumy doc did not even seem concerned. I am going to mention this stool test to my GI that checks for inflammtion though. How can they find inflammtion from checking ones stool??

you make a valid point there....

kiny said:

Probiotics are common strains already found in the intestine, I doubt they cause crohn, some might not be very helpful. We have gazillions of bacteria in our intestine, if our body started attacking common bacteria with macrophages we would be fucked, we wouldn't make it through a single day, that isn't happening. There's a few labs that do tests on mice with species that are easy to induce collitis in and other gastro disease, and they use probiotics, if they saw a negative effect I think they would have pulled on the alarm bell by now.

Click to expand...

As you mention, CRP and ESR can be elevated for a variety of reasons. They're simply a clue that something may or may not be going on that is causing inflammation. They're also useful for helping determine if a treatment is working, if someone might be exiting remission, etc. That's why it's so important to get somewhat regular checkups and to get test results so that we can track these various markers and be proactive. "Hey doc, my CRP is significantly raised for the first time in 15 tests, do you think we should investigate further?"

Fecal lactoferrin is secreted by leukocytes and fecal calprotectin by neutrophils both of which are involved in intestinal inflammation associated with IBD.

Thanks David, I appreciate that info. I will definitely be asking my GI about these stool tests. I hope he has heard of them before. Is this something common that GI's usually do? WTH, I am suprised that he would not have mentioned these to me already, I mean it is non-invasive and could at least give some clues as to what is going on.

On the CRP and sed rate levels, when a person with crohns is in a flare, are these normally elevated high?? I am thinking unless that is the case, these tests would not be very definitive in my case as I have other health issues that could cause these to be elevated as well. I am not even sure what is considered high.

Everyone seems to be different with CRP and sed rate. Some are never elevated, others slightly, and others through the roof.

Yes, your GI should know about those tests.

Normal for CRP is around 0-4. Last time mine was checked it was 9 which is low but present. Some people in bad flares have mentioned theirs being over 300. That's pretty high. Yet arthritis can make it go up as well (any inflammation in the body will make that number go up). What you really want is to know what the number is and then find out what's causing the number to be elevated. Then check it again to see if treatment is working like David mentioned.

An MRI, MRE, CT scan, ultrasound are not invasive and there are some less invasive procedures than a scope like a small or large bowel series (barium x-ray but not really invasive since all you do is take barium and I haven't read anywhere that it destroys intestinal flora) and pill cam (again doesn't kill off bacteria). None of these tests require any form of sedation nor do they destroy intestinal flora (really I don't think any of them are invasive).

Perhaps your GI is waiting for symptoms that are much more dramatic like horrible pain that wont go away or bleeding or something along those lines. In a way it makes sense but catching the disease early is best rather than waiting for it to get really bad you know?

Hey Crabby,

Yeah, I have had the elevated sed rates and CRP on and off for years. The rheumy and other doctors just said it was elevated, but they did not seem concerned. I was just told having any chronic illness can elevate these tests.

As far as the tests you mentioned, well with the large bowel series, you have to drink all that bowel prep for this test and the bowel prep is what flushes out all the gut flora. I am trying to avoid this. I know the small bowel follow through does not require any form of laxatives so this may be an option as far as checking out the small intestines. Not sure how accurate it is, but it is an option I am going to talk to my GI about. What is an MRE scan?? I have heard of the pill cam, but think I would rather do the small bowel follow through as it seems a bit safer.

Yeah, maybe my GI doc is waiting to see if I get worse. Thing is, I am in pain everyday all the time as it is. He keeps saying that IBS can cause debilitating pain for alot of people. ( I guess I just do not know anyone who has IBS as bad as the pain I have. Everyone I know with IBS seems not as bad as I am and they do better with diet change which I have not so far). I have to say I am a bit pissed that my GI did not offer that fecal calprotectin test. At least this can maybe show if there is actual inflammation going on. I mean heck, he did stool tests, why not check for that right??

I want to stay with this GI becuase he is in the best hospital over here( they have good reputation and low-infection rates). Besides all my records are there from my previous GI who moved out of state.

I will say this though, I have noticed my stool is kind of more narrow for the last three days and I feel like I have to push to get it out( like I get the urge I have to go, but then the urge goes away quickly). So then I have to push to get it out and it is more narrow now. Not sure if it because I switched my diet a little in the last week.Not even sure if this is part of IBS or not either. If this keeps up I will likely opt for a colonoscopy then. I mean If I am continually getting worse, then I gotta do what I gotta do I guess and hope for the best. I surely do not want to wait until I am severely sick before I have any tests done. If I insist on the test, he will do it. Thanks again for all the support!

There are also blood tests you can take to see if you have the genes related to Crohn's (I had three of the four of them and even then I had late onset). They also test for the antibodies. The name on my test results was Prometheus but not sure if that's the name of the test or just the place that ran it. I don't see why he wouldn't run those tests as they are just blood tests.

Ihurt said:

As far as the tests you mentioned, well with the large bowel series, you have to drink all that bowel prep for this test and the bowel prep is what flushes out all the gut flora.

Click to expand...

You're thinking of a colonoscopy. A large bowel series is similar to the small bowel series (you drink barium and they do x-rays) except you don't drink barium. You get a barium enema and then they do x-rays. It's not a fun test but just like the small bowel series it can show inflammation, ulcers, scar tissue, things like that.

With the large bowel series, you have to have the same prep as with the colonoscopy to clear the bowels. This is really the main reason why I have not had the colonoscopy. The prep they use before the colonoscopy and the large bowel series is the same ( you get induced diarhea) which is the problem for me. The laxatives deplete your gut flora which in turn leaves you very vunerable to other infections( c-diff etc..). Since I have been on an antibiotic low dose for 4 years to prevent the UTI's I am so prone to getting I am at double risk of having issues from the prep for these tests.Also. I am extrememly prone to UTI's,and Diarhea always causes me infections no matter how clean I am. I however could do the small bowel series as I do not think they have you drink laxatives before this procedure. I am going to talk to my GI about these tests when I see him. Thanks again, I appreciate all the help.

Crabby said:

You're thinking of a colonoscopy. A large bowel series is similar to the small bowel series (you drink barium and they do x-rays) except you don't drink barium. You get a barium enema and then they do x-rays. It's not a fun test but just like the small bowel series it can show inflammation, ulcers, scar tissue, things like that.

Click to expand...

I don't recall having to do prep before the large bowel series, then again I was on a liquid diet at the time already in the hospital so maybe that's why.