Prevalence and clinical impact of endoscopic pseudomembranes in patients with inflammatory bowel disease and Clostridium difficile infection.
OBJECTIVE
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.
Sheba Medical Center, Tel-Aviv University, Israel. sben-horin@013.net.il
Shomron
S
Ben-Horin
Maya
M
Margalit
Peter
P
Bossuyt
Jochen
J
Maul
Yami
Y
Shapira
Daniela
D
Bojic
Irit
I
Chermesh
Ahmad
A
Al-Rifai
Alain
A
Schoepfer
Matteo
M
Bosani
Matthieu
M
Allez
Peter Laszlo
PL
Lakatos
Fabrizio
F
Bossa
Alexander
A
Eser
Tommaso
T
Stefanelli
Franck
F
Carbonnel
Konstantinos
K
Katsanos
Davide
D
Checchin
Inés Sáenz
IS
de Miera
Walter
W
Reinisch
Yehuda
Y
Chowers
Gordon William
GW
Moran
D000328:Adult; D001706:Biopsy; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D003106:Colon / Q000473:pathology*; D003113:Colonoscopy; D004761:Enterocolitis, Pseudomembranous / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000453:epidemiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies