Patients with Clostridium difficile infection have a high risk for developing post-infectious irritable bowel syndrome, particularly those with longer duration of C. difficile infection, anxiety and higher BMI, according to a recent study published in Alimentary Pharmacology and Therapeutics.
“Post-infectious irritable bowel syndrome (PI-IBS) develops after gastrointestinal infections in about 10% of individuals,” Madhusudan Grover, MBBS, from the division of gastroenterology and hepatology at the Mayo Clinic in Rochester, Minn., told Healio Gastroenterology. “Although Clostridium difficile infections (CDI) are increasingly common, the epidemiology of PI-IBS following CDI was unclear.”
To assess the incidence and risk factors for PI-IBS after CDI, Grover and colleagues, including Sahil Khanna, MBBS, identified 684 CDI cases between September 2012 and November 2013 within the Mayo Clinic microbiology laboratory database. They then mailed surveys to these patients to ascertain data on demographics, Rome III diagnostic criteria for IBS, IBS symptom severity, anxiety and depression, which were to be completed within 6 to 9 months of the CDI episode.
The response rate was 46%. Of the 315 respondents, 205 did not meet criteria for IBS before their CDI and were defined as at risk for developing PI-IBS.
“We found that a quarter of our survey responders without IBS prior to CDI have developed PI-IBS following the CDI,” Grover said, which is higher than the median PI-IBS incidence following infection from other pathogens. Of these 52 patients, 52% had mixed IBS and 40% had diarrhea-predominant IBS.
“Those with CDI symptoms [more than] 7 days, ongoing anxiety and a higher BMI were more likely to have the diagnosis of PI-IBS,” Grover added.
A multivariable logistic regression model showed CDI symptom duration more than 7 days was independently associated with a higher risk for PI-IBS (OR = 2.96; 95% CI, 1.24-7.1), as were current anxiety scores on the hospital anxiety and depression scale (OR = 1.33; 95% CI, 1.16-1.53) and higher BMI (OR = 1.08; 95% CI, 1.02-1.14). Moreover, blood in stool during CDI was associated with a reduced risk for PI-IBS (OR = 0.44; 95% CI, 0.19-1.02).
“Clinicians should consider the possibility of PI-IBS while assessing patients with ongoing symptoms after CDI, and further research is needed to determine pathophysiological mechanisms of PI-IBS following CDI,” Grover said. – by Adam Leitenberger
The researchers report no relevant financial disclosures.