Korean J Gastroenterol.  2022 Aug;80(2):66-71. 10.4166/kjg.2022.097.

Clostridioides Infection in Patients with Inflammatory Bowel Disease

• Lee MR
• Kim ES

• KMID: 2532680
• DOI: http://doi.org/10.4166/kjg.2022.097

Abstract

Inflammatory bowel disease (IBD), comprising Crohn’s disease and ulcerative colitis, is a chronic inflammatory condition of the gastrointestinal tract, which is often accompanied by altered gut microbial composition. Gut dysbiosis in IBD is considered to be the reason for the high risk of Clostridioides difficile infection (CDI) in patients with IBD. Therefore, CDI should be evaluated in IBD patients with a symptom flare. Medical treatment of non-severe CDI in IBD is similar to that in non-IBD patients and includes oral vancomycin or fidaxomicin. The risk of recurrent CDI in IBD is higher than in non-IBD patients and this could be mitigated by fecal microbiota transplantation. As CDI may worsen the clinical outcomes of IBD, patients should be carefully monitored and an escalation of IBD therapy needs to be considered when there is no improvement seen with the antimicrobial treatment of CDI. This review discusses the risk, pathophysiology, diagnosis, and management of CDI in IBD.

Keyword

Clostridioides difficile Infection; Clostridioides difficile Infection; Inflammatory bowel diseases; Inflammatory bowel diseases; Colitis; Colitis; ulcerative; ulcerative; Crohn disease; Crohn disease

Figure

• 

  Fig. 1 Medical management of CDI in IBD. IBD, inflammatory bowel disease; CDI, Clostridioides difficile infection; FMT, fecal microbiota transplantation. aMetronidazole can be used if there is no risk of resistance to metronidazole; bFidaxomicin is not available in Korea currently.

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