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P683 C.difficile colonisation or infection does not appear to increase the risk of a diagnosis of IBD in the subsequent 2 years

N. Joshi*1, R. Crowson1, D. Ball2, D. Rampton1

1Queen Mary, University of London, Blizard Institute, Centre for Digestive Diseases, London, United Kingdom, 2Barts Health NHS Trust, Medical Microbiology, London, United Kingdom

Background

Epidemiological studies have shown that gastroenteritis[1] and infection with Campylobacter or Salmonella species increase the chance of subsequent diagnosis of IBD[2]. About 1% patients with Campylobacter/Salmonella have a later diagnosis of IBD, 37% within a 1 year; the risk is higher if the infection causes admission[2]. To assess whether C.difficile colonisation (CDC) or infection (CDI) confer a risk for later IBD, we have examined all cases of CDC and CDI in non-IBD patients at our hospital during the year ending April 2013.

Methods

The microbiology database (Barts Health NHS Trust) was retrospectively searched for all stool samples testing positive for CDC and/or CDI during the year to April 2013. CDC was defined as the presence of the C.difficile-specific enzyme (glutamate dehydrogenase) and CDI as the presence of toxin B. Follow up data to see if these patients went on to be diagnosed with IBD from date of sample to end October 2014 was gathered from electronic patient records.

Results

2486 stool samples were analysed for CDC/CDI. 11% (271) samples from patients with known IBD were excluded. Overall, 12% (273/2215) samples showed CDC and 3% (71/2215) CDI. Median (range) ages were 61.2 (1.1- 98.3) years for CDC and 60.7 (1.1-90.8) years for CDI (p=ns). 15% (265/2006) inpatient samples and 7% (8/109) of outpatient samples were CDC-positive (p=ns) with inpatient and outpatient CDI rates being 3% (67/2006) and 4% (4/109) respectively (p=ns). None of the CDC or CDI patients went on to be diagnosed with IBD within the follow up period of 2 (1.5-2.5) years (median (range)).

Conclusion

In our cohort of 273 infected patients, CDC/CDI did not result in a diagnosis of IBD in any patients after a median of 2 years follow up. Any increased risk of IBD after CDC or CDI is likely to be small.

References:

[1] García Rodríguez LA et al, (2006), Acute gastroenteritis is followed by an increased risk of inflammatory bowel disease., Gastroenterology, 130:1588-94

[2] Gradel KO et al , (2009), Increased short- and long-term risk of inflammatory bowel disease after salmonella or campylobacter gastroenteritis., Gastroenterology , 137:495-501