Ulcerative Colitis Blog

In a recent blog regarding UC and fecal biotherapy, mention was made about a gastrointestinal infection known as Clostridium difficile or C. diff for short. I wanted to expand on this topic as patients with IBD, and particularly UC, have a predilection for becoming ill with C. diff infections.

C. diff is a bacterium that commonly resides in the gut. The population of C. diff in the gut is usually small because other bacteria in the intestine keep it in check. At times, however, the balance of bacterial populations in the gut can be thrown off allowing the C. diff type of bacteria to overgrow. Overgrowth of C. diff results in severe diarrhea that may or may not be bloody and abdominal pain. Precipitants that can disrupt this balance of bacteria include antibiotics, proton pump inhibitor medication (ie; omeprazole, rabeprazole), immunocompromise, and exposure to hospitalized settings or nursing homes. It is easily diagnosed through collection of 2-3 stool specimens. The infection is treated with antibiotics such as metronidazole and vancomycin that restore the appropriate bacterial balance.

A study published in 2007 showed that IBD patients who are hospitalized are 3 times as likely to have a C. diff infection as other hospitalized individuals without IBD. Furthermore, when patients were sub-divided into those with Crohn's vs. UC, hospitalized individuals with UC were found to be 4 times as likely to have C. diff compared to hospitalized individuals without IBD. As we learn more about C. diff, we are finding that it is not only a problem in hospitalized patients, but also for those living everyday life in the community. As such, it is important that IBD patients are educated about this infection because it can be a cause if flare symptoms. Any patient experiencing worsening diarrhea and abdominal pain should review their risk factors for the infection with their doctor and consider stool analysis for the bacteria.

UC is a chronic gastrointestinal illness that follows a course of relapsing and remitting disease. Perhaps one of the most frustrating aspects of UC for patients is the abrupt onset and unpredictability of disease flares. A recent study suggested that the risk of relapse in UC is 40%, 57%, and 67%, at 2, 5, and 10 years, respectively. While there is no crystal ball to forewarn individuals when the next flare may arise, investigators have identified some factors which may be associated with a greater risk of relapse:

1) Relapse within the first year of diagnosis. Early relapse, defined as a disease flare within the first year of diagnosis, has been associated with having a greater number flares in the future. It is thought that early disease recurrence may suggest a more severe form of disease that requires aggressive treatment.

2) Younger age at diagnosis. Individuals diagnosed with UC under the age of 30 years may be at risk for earlier and more frequent flares. The reason for this is unknown, but may be related to genetic predisposition or constitution of the immune system.

3) Cessation of cigarette smoking. In a subset of patients with UC who are smokers, stopping smoking is associated with disease onset. Similarly, there is evidence to suggest that cessation of smoking in this group may increase disease flares. Such individuals also appear to have a higher risk of disease relapse then never smokers.

4) Not taking medication as prescribed. Studies have shown that up to 60% of UC patients admit to not taking their medication regularly (taking < 70% of prescribed medication). These individuals are 5 times more likely to have a disease flare than someone who is adherent to their prescription instructions.