Enteric infections common in IBD flares

Last Updated: 2018-08-24

By Will Boggs MD

NEW YORK (Reuters Health) - About one in six patients experiencing flares of inflammatory bowel disease (IBD) have non-Clostridium difficile enteric infections, according to a new study.

"There is growing data regarding the role of gastrointestinal infections in both the pathogenesis and maintenance of inflammatory bowel disease," said Dr. Jordan E. Axelrad from NYU Langone Health and Columbia University Medical Center, in New York City.

"We believe these novel data add substantially to the field and suggest unique hypotheses regarding how specific infections may play an important role in modulating the mucosal immune response," he told Reuters Health by email.

Dr. Axelrad's team used electronic medical records of 277 patients with Crohn's disease (CD), 300 patients with ulcerative colitis (UC), and more than 8,000 patients without IBD. Collectively, the patients underwent 13,231 stool tests with a gastrointestinal pathogen PCR panel during a diarrheal illness, to evaluate the distribution of non-C. difficile enteric infections.

Among patients with CD, 18.1% of tests were positive for a total of 122 pathogens; 16.1% of tests in UC patients were positive for a total of 115 pathogens; and 26.6% of tests in patients without IBD were positive for 4,431 pathogens, the researchers report in The American Journal of Gastroenterology, online August 3.

Compared with patients without IBD, CD patients had significantly higher odds of norovirus and lower odds of parasites, whereas UC patients had lower odds of norovirus and parasites and higher odds of bacteria (specifically, Campylobacter and E. coli species).

Among patients who underwent upper endoscopy, findings of esophagitis were more common in patients with an infection, but there were no other endoscopic predictors of a positive test, and there were no histologic findings associated with a positive pathogen test result in patients who underwent biopsy.

IBD patients who tested negative for gastrointestinal pathogens were more likely to have IBD medications added or up-titrated, while IBD patients are tested positive were more likely to have IBD medications held or to have no changes in their IBD management.

In the exploratory analyses, patients who received antimicrobial therapy for a positive test were equally as likely to remain in remission during the follow-up period as were patients who did not receive antimicrobial therapy.

"The similar clinical presentations and laboratory findings in relapse of inflammatory and enteric infection pose substantial barriers to diagnosis and treatment," Dr. Axelrad said. "Moreover, endoscopic and histologic findings did not differentiate flare from gastrointestinal infection."

"As such," he said, "PCR stool testing may identify potential pathogens for targeted treatment; however, prospective data regarding management of flares complicated by infection and follow-up outcomes require further study."

SOURCE: https://bit.ly/2P1S2UV

Am J Gastroenterol 2018.