Clostridium difficile in Inflammatory Bowel Disease

The incidence and severity of Clostridium difficile infection (CDI) have more than doubled over the past decade, leading to increased hospitalization rates and length of stay, with significant morbidity and mortality. It is estimated that the financial burden of CDI on the health care system in the United States costs billions of dollars. Recent studies have demonstrated that patients with inflammatory bowel disease (IBD; Crohn's disease, ulcerative colitis) are at an increased risk for developing CDI and experience increased morbidity and mortality, as well as an increased need for emergent colectomy. CDI may mimic an IBD flare, even in patients who have had a colectomy (C difficile enteritis); thus, a high suspicion should be maintained, as prompt diagnosis and treatment have been shown to improve outcomes. Currently, oral metronidazole is the treatment of choice for mild to moderate CDI, with oral vancomycin being reserved for patients with severe CDI. At this time, there are no clear guidelines for treatment of CDI in patients with IBD; prospective randomized control trials are needed. In this article, we summarize the epidemiology, pathogenesis, risk factors, clinical features, and treatment (both medical and surgical) of CDI in patients with IBD.