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Review
. 2021 Jul 1;37(4):336-343.
doi: 10.1097/MOG.0000000000000739.

Diagnosis and management of Clostridioides difficile infection in patients with inflammatory bowel disease

Rahul S Dalal  1 , Jessica R Allegretti
Affiliations
Review

Diagnosis and management of Clostridioides difficile infection in patients with inflammatory bowel disease

Rahul S Dalal et al. Curr Opin Gastroenterol. .

Abstract

Purpose of review: Clostridioides difficile infection (CDI) may complicate the course of ulcerative colitis and Crohn's disease. The clinical presentation of CDI in this population is often atypical, and patients may experience exacerbations of their underlying inflammatory bowel disease (IBD) secondary to C. difficile. In this review, we aim to review the risk factors, diagnosis, and management of CDI in the context of IBD.

Recent findings: Patients with colonic involvement of their IBD are at higher risk for CDI and colonization may be more common than in the general population. Therefore, CDI is confirmed using a two-step approach to stool testing. Oral vancomycin or fidaxomicin are the preferred agents for nonfulminant disease, and oral metronidazole is no longer recommended as first-line therapy. For all patients with CDI recurrence, fecal microbiota transplant (FMT) should be considered, as this has been shown to be safe and effective. Among those who have worsening of their underlying IBD, retrospective research suggest that outcomes are improved for those who undergo escalation of immunosuppression with appropriate antimicrobial treatment of C. difficile, however prospective data are needed.

Summary: CDI may complicate the course of IBD, however the presentation may not be typical. Therefore, all patients with worsening gastrointestinal symptoms should be evaluated for both CDI and IBD exacerbation. Providers should consider FMT for all patients with recurrent CDI as well as escalation of immunosuppression for patients who fail to improve with appropriate antimicrobial therapy.

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Conflict of interest statement

Conflicts of interest: JRA serves as a consultant for Takeda, Janssen, Pfizer, Pandion, Servatus, Finch Therapeutics, Iterative Scopes and Artugen and has grant support from Merck. RSD has no financial or personal conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Comprehensive diagnostic and management algorithm of CDI in IBD Abbreviations: IBD = inflammatory bowel disease, CDI = C. difficile infection, EIA = enzyme immunoassay, GDH = glutamate dehydrogenase, PCR = polymerase chain reaction, PO = oral, NGT = nasogastric tube, FMT = fecal microbiota transplant
See this image and copyright information in PMC

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