Editorial
Copyright copy;2010 Baishideng Publishing Group Co.
World J Gastroenterol. Oct 21, 2010; 16(39): 4892-4904
Published online Oct 21, 2010. doi: 10.3748/wjg.v16.i39.4892
Table 1 Short and long-term outcomes with Clostridium difficile infection and inflammatory bowel disease
Short-term outcomes
Toxic megacolon
Colonic perforation
Peritonitis with sepsis
? Increased hospitalization duration and costs
Colectomy rates highly variable
Long-term outcomes
Increased UC related hospitalization and emergency room visits
? Escalation of medical treatment
Increased rate of colectomy
Table 2 Differentiating Clostridium difficile infection and inflammatory bowel disease
FeaturesIsolated CDICDI and IBD
SettingOften hospital acquiredOften community-acquired
Risk factorsAntibiotic exposure prior to infection commonMany patients lacking of history of antibiotic exposure
Immunomodulator and corticosteroid useImmunomodulator and corticosteroid use playing even a greater role
Increasing ageIncreasing age
Risk greater with ulcerative colitis than Crohn’s disease, more with colonic involvement than small bowel disease
Clinical featuresUsually watery diarrheaMay be bloody or mucous diarrhea
OutcomeShort term complications including toxic megacolon, colonic perforation, and peritonitis with sepsisShort term complications including toxic megacolon, colonic perforation, and peritonitis with sepsis similar to patients without IBD
Hospitalization costs and length of stay variable in studies
Increased mortality in some studies
Risk of colectomy unclear
Long term outcome unclear, increased hospitalizations and escalation in medication use and colectomy rates reported with retrospective data
DiagnosisELISA testing for toxinsELISA testing may be less sensitive
Endoscopy and histologyPseudomembranes commonPseudomembranes rare
TreatmentMetronidazole for mild to moderate severity? Vancomycin for any hospitalized IBD patient
Vancomycin for severe disease
Recurrence20% after the first episode of CDIRates highly variable 10%-58%, may be higher
Extra-colonic gastrointestinal manifestationsSmall bowel can be affectedMost cases of small bowel involvement in IBD patients
Pouchitis can also be seen