Prevalence and clinical impact of endoscopic pseudomembranes in patients with inflammatory bowel disease and Clostridium difficile infection

Shomron Ben-Horin, Maya Margalit, Peter Bossuyt, Jochen Maul, Yami Shapira, Daniela Bojic, Irit Chermesh, Ahmad Al-Rifai, Alain Schoepfer, Matteo Bosani, Matthieu Allez, Peter Laszlo Lakatos, Fabrizio Bossa, Alexander Eser, Tommaso Stefanelli, Franck Carbonnel, Konstantinos Katsanos, Davide Checchin, Inés Sáenz de Miera, Walter ReinischYehuda Chowers, Gordon William Moran

Research output: Contribution to journalArticle

Abstract

Background and aim: Limited data suggests that pseudomembranes are uncommon in patients with inflammatory bowel disease (IBD) and C. difficile associated disease (CDAD), but the reason for this is unknown. We aimed to evaluate the rate of pseudomembranes in this population, identify predictive factors for pseudomembranes' presence and assess its clinical impact. Methods: This was a sub-study of a retrospective European Crohn's & Colitis Organization (ECCO) multi-center study on the outcome of hospitalized IBD patients with C. difficile. The present study included only patients who underwent lower endoscopy during hospitalization, and compared demographic and clinical parameters in the group of patients with discernable pseudomembranes versus those without. Results: Out of 155 patients in the original cohort, 93 patients underwent lower endoscopy and constituted the study population. Endoscopic pseudomembranes were found in 12 (13%) of these patients. Patients with pseudomembranes presented more commonly with fever (p = 0.02) compared to patients without pseudomembranes. No difference between the two groups was found with respect to the use of immunosuppressant drugs, background demographics or disease characteristics. Neither was there a difference between the group with or without pseudomembranes in the frequency of severe adverse clinical outcome or in the duration of hospitalization. On multi-variate analysis the presence of fever remained independently associated with the finding of pseudomembranes (OR 6, 95% CI 1.2-32, p = 0.03). Conclusions: This study documents that hospitalized IBD patients with CDAD have low rate of endoscopic pseudomembranes, which is not accounted for by the use of immunosuppressant drugs. IBD patients with CDAD and discernable pseudomembranes more commonly present with fever, but their clinical outcome is similar to patients without pseudomembranes.

Original languageEnglish
Pages (from-to)194-198
Number of pages5
JournalJournal of Crohn's & colitis
Volume4
Issue number2
DOIs
Publication statusPublished - Jun 2010

Keywords

  • Clostridium difficile;
  • Infection
  • Inflammatory bowel disease;

ASJC Scopus subject areas

  • Gastroenterology

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    Ben-Horin, S., Margalit, M., Bossuyt, P., Maul, J., Shapira, Y., Bojic, D., Chermesh, I., Al-Rifai, A., Schoepfer, A., Bosani, M., Allez, M., Lakatos, P. L., Bossa, F., Eser, A., Stefanelli, T., Carbonnel, F., Katsanos, K., Checchin, D., de Miera, I. S., ... Moran, G. W. (2010). Prevalence and clinical impact of endoscopic pseudomembranes in patients with inflammatory bowel disease and Clostridium difficile infection. Journal of Crohn's & colitis, 4(2), 194-198. https://doi.org/10.1016/j.crohns.2009.11.001