Recent developments on the role of Clostridium difficile in inflammatory bowel disease.
Clostridium difficile (CD), specifically its toxins, have been implicated as a risk factor for exacerbation of the inflammatory process in up to 5% of patients with ulcerative colitis or Crohnos disease. Typical evidence of colonic changes with CD infection, including pseudomembranous exudate, are often not present; however, a severe clinical course may result, including precipitation of toxic colitis and toxic megacolon. Recently, hypervirulent CD strains have been reported raising concern for a more severe disease process in patients with underlying inflammatory bowel disease. Moreover, small bowel involvement or CD enteritis has been increasingly described, usually in those with a history of a prior colectomy or total proctocolectomy for prior severe and extensive inflammatory bowel disease. Finally, refractory or treatment-resistant pouchitis may occur with CD infection.
Freeman
Hugh James
HJ
Department of Medicine Gastroenterology, University of British Columbia, 2211 Wesbrook Mall, Vancouver V6T 1W5, Canada. hugfree@shaw.ca
D001426:Bacterial Proteins / Q000502:physiology; D001427:Bacterial Toxins; D016360:Clostridioides difficile / Q000502:physiology*; D004761:Enterocolitis, Pseudomembranous / Q000150:complications; D004768:Enterotoxins / Q000502:physiology; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000453:epidemiology / Q000382:microbiology* / Q000503:physiopathology*; D007413:Intestinal Mucosa / Q000382:microbiology; D012307:Risk Factors
D001426:Bacterial Proteins; D001427:Bacterial Toxins; D004768:Enterotoxins; C041348:tcdA protein, Clostridium difficile; C031815:toxB protein, Clostridium difficile