Ulcerative Colitis Resource Center

Ulcerative Colitis Resource Center

September 27, 2018
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Corticosteroid escalation predicts colon surgery in IBD patients with CDI

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Escalating corticosteroid therapy for inflammatory bowel disease during a Clostridium difficile infection was linked with a higher risk for colon surgery, according to research published in Inflammatory Bowel Diseases.

Sahil Khanna, MBBS, of the division of gastroenterology and hepatology at the Mayo Clinic in Rochester, Minnesota, and colleagues wrote that managing patients with IBD and CDI can be difficult because CDI cannot be distinguished clinically from an IBD exacerbation.

“Patients with [IBD] are at an increased risk for developing both initial and recurrent CDI regardless of the presence of traditional risk factors such as older age, antibiotic exposure, and hospitalization,” they wrote. “In IBD, active colitis due to an IBD exacerbation leads to disruption of the gut microbiome, thereby facilitating colonization and active infection by toxigenic C. difficile spores even without antibiotic exposure. ... In addition, an inflammatory response triggered by C. difficile toxins on the colonic mucosa can often lead to IBD exacerbation.”

To find factors associated with adverse outcomes in IBD with CDI, investigators analyzed data from 137 patients with IBD (mean age, 46 years; 55% women); 70 patients had ulcerative colitis (51%), 63 had Crohn’s disease (46%), and 4 had indeterminate colitis (3%). They examined the patients’ IBD severity before CDI diagnosis, CDI management, subsequent IBD exacerbation, CDI recurrence and colon surgery.

After investigating several types of IBD treatment, including immunomodulators and biologics, Khanna and colleagues found that only corticosteroid escalation was a positive predictor of colon surgery within one year of CDI (OR = 5.94; 95% CI, 2.03–17.44). However, modifying corticosteroid therapy did not affect CDI recurrence or future risk for IBD exacerbation.

Additionally, researchers found that older age was a negative predictor (OR = 0.09; 95% CI, 0.01–0.44).

Khanna and colleagues wrote that patients with increasing CDI severity were more likely to have corticosteroids added to their regimen or escalated, while their immunomodulator dosage was either cut or eliminated.

“Prospective studies are needed to determine the optimal timing for initiation or dose-escalation of immunosuppressive therapy in patients with IBD and CDI,” they wrote. “However, in the absence of current prospective data, these findings add to the understanding of CDI management in this high-risk population and can help guide patient care and future prospective research in the field.” – by Alex Young

Disclosures: Healio Gastroenterology and Liver Disease could not confirm the authors’ relevant financial disclosures prior to publication.