How Infection with C. difficile Infection Aggravates Inflammatory Bowel Disease: Is It CDI or the CDAI?
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EDITORIAL
How Infection with C. difficile Infection Aggravates Inflammatory Bowel Disease: Is It CDI or the CDAI? Hamidreza Houri1 · Abbas Yadegar1 · Mohammad Reza Zali2 Accepted: 6 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Inflammatory bowel disease (IBD) is regarded as a lifelong, relapsing–remitting inflammatory disorder of the gastrointestinal (GI) tract, with an unknown etiology and unpredictable clinical course [1]. GI infections commonly trigger relapse in patients with IBD; among these infections, Clostridioides (formerly Clostridium) difficile infection (CDI) is reported as the most common GI infection in patients with IBD, with recurrence in up to one-third of patients. CDI frequently complicates the subsequent course of IBD, delays IBD remission, and increases the need for colectomy, and even increases mortality rates [2]. Risk factors contributing to the acquisition and severity of CDI in IBD are preexisting colonic inflammation, especially in ulcerative colitis (UC), concomitant immunosuppression, prolonged hospitalization, and long-term antibiotic use. Though the clinical manifestations of an IBD flare and CDI have considerable overlap, the treatment strategies are markedly different with escalation of immunosuppression for an IBD flare compared with reduction in immunosuppression and antibiotics for active CDI [3]. Although IBDassociated inflammation could predispose patients to CDI, CDI may exacerbate IBD by triggering a mucosal inflammatory response or by reducing the diversity of the luminal microbiota [4]. Accordingly, whether IBD disease severity predisposes to the development of the CDI or whether CDI exacerbates IBD has often been presented as a problem of origin and first cause.
* Abbas Yadegar [email protected]; [email protected] 1
Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2
In this issue of Digestive Diseases and Sciences, Varma and colleagues [5] retrospectively evaluated patients hospitalized for ≥ 2 IBD flares at New York–Presbyterian Columbia University Irving Medical Center from January 2010 to September 2019. The authors compared the time to IBD flare between patients who were hospitalized for a flare complicated by CDI and subsequently for a CDInegative flare (± ; cohort A) versus patients who were hospitalized for two CDI-negative flares (−/−; cohort B). They also determined the time between flares among the subset of cohort A patients who had three flares (−/± ; cohort C) before and after CDI. As a result, they reported that patients with prior CDI had significantly shorter time to IBD relapse compared with those without any history of CDI. On the contrary, among patients with IBD who had CDI, the interval between flare
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