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World J Gastroenterol. May 14, 2008; 14(18): 2794-2796
Published online May 14, 2008. doi: 10.3748/wjg.14.2794
Recent developments on the role of Clostridium difficile in inflammatory bowel disease
Hugh James Freeman
Hugh James Freeman, Department of Medicine (Gastroenterology), University of British Columbia, Vancouver V6T 1W5, Canada
Author contributions: Freeman HJ contributed all to this paper.
Correspondence to: Dr. Hugh James Freeman, MD, FRCPC, FACP, Department of Medicine Gastroenterology, University of British Columbia, 2211 Wesbrook Mall, Vancouver V6T 1W5, Canada. hugfree@shaw.ca
Telephone: +1-604-8227216
Fax: +1-604-8227236
Received: March 3, 2008
Revised: March 29, 2008
Published online: May 14, 2008
Abstract

Clostridium difficile (CD), specifically its toxins, have been implicated as a risk factor for exacerbation of the inflammatory process in up to 5% of patients with ulcerative colitis or Crohn’s disease. Typical evidence of colonic changes with CD infection, including pseudomembranous exudate, are often not present; however, a severe clinical course may result, including precipitation of toxic colitis and toxic megacolon. Recently, hypervirulent CD strains have been reported raising concern for a more severe disease process in patients with underlying inflammatory bowel disease. Moreover, small bowel involvement or CD enteritis has been increasingly described, usually in those with a history of a prior colectomy or total proctocolectomy for prior severe and extensive inflammatory bowel disease. Finally, refractory or treatment-resistant pouchitis may occur with CD infection.

Keywords: Crohn’s disease; Ulcerative colitis; Antibiotic-associated colitis; Cytotoxin; Enterotoxin; Pseudomembranous colitis; Clostridium difficile colitis