Antibiotic use during gastrointestinal infections increases the risk of developing irritable bowel syndrome: a Systematic Review and Meta-Analysis

Introduction: Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction which negatively affects patients' quality of life. It has been hypothesized that changes in gut microbiota composition and function evoked by antibiotic use represent a trigger for IBS development. This systematic review and meta-analysis aims to assess the incidence of IBS following antibiotic use. Methods: Medline, Embase, and Scopus, along with relevant conference abstracts and citation tracking were searched up to June 15th, 2025. Studies that reported new diagnoses of IBS in patients with documented antibiotic exposure versus controls without antibiotic exposure were included. Data extraction and quality assessment were performed independently by two reviewers. Pooled incidence rates per 1000 person-years, along with incidence rate ratios (IRRs) with 95% confidence intervals (CI) were pooled; heterogeneity was expressed as I2. Meta-regression analysis was performed to assess the impact of confounding covariates. Results: Thirty-one studies comprising a total of 422,350 patients (244,632 antibiotic users and 177,718 non-users) were included. The overall pooled incidence of IBS was 26% in antibiotic users compared to 20% in non-users, resulting in an IRR of 1.3 (95% CI: 1.07-1.58; p = 0.008). In sensitivity analyses including only studies in which antibiotics were used for gastrointestinal infections, the risk of developing IBS was higher for antibiotic users (IRR: 1.71; 95% CI: 1.16-2.51; p = 0.007), with high heterogeneity (I2 > 90%) among studies. Geographical area, criteria for IBS diagnosis and study quality were associated with estimated effects, explaining the observed heterogeneity. Conclusion: Antibiotic use is associated with increased risk of developing IBS, especially following gastrointestinal infections. However, the significant study heterogeneity reduces the power of our results, suggesting that further high-quality research is needed to clarify this relationship.