Systematic Review
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 21, 2017; 23(27): 4986-5003
Published online Jul 21, 2017. doi: 10.3748/wjg.v23.i27.4986
Management of inflammatory bowel disease with Clostridium difficile infection
Julie D’Aoust, Robert Battat, Talat Bessissow
Julie D’Aoust, Division of Internal Medicine, Jewish General Hospital, Montreal QC H3G 1A4, Canada
Robert Battat, Division of Gastroenterology, Jewish General Hospital, Montreal QC H3G 1A4, Canada
Robert Battat, Talat Bessissow, Division of Gastroenterology, McGill University Health Centre, Montreal QC H3G 1A4, Canada
Author contributions: D’Aoust J and Battat R should be as co-first authors and contributed equally to the study; D’Aoust J, Battat R and Bessissow T planning and conducting the study; D’Aoust J, Battat R and Bessissow T collected data, drafting the manuscript.
Conflict-of-interest statement: D’Aoust J and Battat R confirm that there are no conflicts of interest to declare; Bessissow T has received fees as a speaker for Janssen, Shire, Abbvie, Takeda, Ferring, and Pendopharma; Bessissow T has a research grant from Abbvie, Janssen; Bessissow T has consulted for Abbvie, Takeda, Shire.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Talat Bessissow, MD, FRCPC, Division of Gastroenterology, McGill University Health Centre, 1650 Avenue Cedar C7-200, Montreal QC H3G 1A4, Canada. talat.bessissow@mcgill.ca
Telephone: +1-514-9341934 Fax: +1-514-9348531
Received: March 24, 2017
Peer-review started: March 29, 2017
First decision: April 26, 2017
Revised: May 16, 2017
Accepted: June 18, 2017
Article in press: June 19, 2017
Published online: July 21, 2017
Abstract
AIM

To address the management of Clostridium difficile (C. difficile) infection (CDI) in the setting of suspected inflammatory bowel disease (IBD)-flare.

METHODS

A systematic search of the Ovid MEDLINE and EMBASE databases by independent reviewers identified 70 articles including a total of 932141 IBD patients or IBD-related hospitalizations.

RESULTS

In those with IBD, CDI is associated with increased morbidity, including subsequent escalation in IBD medical therapy, urgent colectomy and increased hospitalization, as well as excess mortality. Vancomycin-containing regimens are effective first-line therapies for CDI in IBD inpatients. No prospective data exists with regards to the safety or efficacy of initiating or maintaining corticosteroid, immunomodulator, or biologic therapy to treat IBD in the setting of CDI. Corticosteroid use is a risk factor for the development of CDI, while immunomodulators and biologics are not.

CONCLUSION

Strong recommendations regarding when to initiate IBD specific therapy in those with CDI are precluded by a lack of evidence. However, based on expert opinion and observational data, initiation or resumption of immunosuppressive therapy after 48-72 h of targeted antibiotic treatment for CDI may be considered.

Keywords: Biologic therapy, Clostridium difficile, Inflammatory bowel disease, Ulcerative colitis, Crohn’s disease, Corticosteroids

Core tip:Clostridium difficile infection (CDI), common and increasing in inflammatory bowel disease (IBD), is associated with worse outcomes in IBD. Vancomycin-containing regimens are effective first-line therapies for CDI in IBD. Ambiguity exists on the treatment of IBD flare in patients with CDI; however, case reports suggest corticosteroid initiation after appropriate antibiotic therapy may be effective.