This commissioned systematic review was subject to full peer-review.
Systematic review: Clostridium difficile and inflammatory bowel disease
Article first published online: 30 DEC 2010
© 2010 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 33, Issue 4, pages 428–441, February 2011
How to Cite
Goodhand, J. R., Alazawi, W. and Rampton, D. S. (2011), Systematic review: Clostridium difficile and inflammatory bowel disease. Alimentary Pharmacology & Therapeutics, 33: 428–441. doi: 10.1111/j.1365-2036.2010.04548.x
- Issue published online: 16 JAN 2011
- Article first published online: 30 DEC 2010
- Publication data Submitted 5 October 2010 First decision 16 November 2010 Resubmitted 23 November 2010 Accepted 24 November 2010
Background There is increasing concern about the apparently rising incidence and worsening outcome of Clostridium difficile infection (CDI) associated with inflammatory bowel disease (IBD). We have systematically reviewed the literature to evaluate the incidence, risk factors, endoscopic features, treatment and outcome of CDI complicating IBD.
Aim To systematically review: clostridium difficile & inflammatory bowel disease.
Methods Structured searches of Pubmed up to September 2010 for original, cross-sectional, cohort and case-controlled studies were undertaken.
Results Of 407 studies, 42 met the inclusion criteria: their heterogeneity precluded formal meta-analysis. CDI is commoner in active IBD, particularly ulcerative colitis, than in controls. Certainty about a temporal trend to its increasing incidence in IBD is compromised by possible detection bias and miscoding. Risk factors include immunosuppressants and antibiotics, the latter less commonly than in controls. Endoscopy rarely shows pseudomembranes and is unhelpful for diagnosing CDI in IBD. There are no controlled therapeutic trials of CDI in IBD. In large studies, outcome of CDI in hospitalised IBD patients appears worse than in controls.
Conclusions The complication of IBD by Clostridium difficile infection has received increasing attention in the past decade, but whether its incidence is really increasing or its outcome worsening remains unproven. Therapeutic trials of Clostridium difficile infection in IBD are lacking and are needed urgently.