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2162: The impact of Clostridium difficile infection on disease severity in patients with inflammatory bowel disease
- Alyce J. M. Anderson, Claudia Ramos-Rivers, Benjamin Click, Debbie Cheng, Ioannis Koutroubakis, Jana Al Hashash, Michael Dunn, Marc Schwartz, Jason Swoger, Arthur Barrie, Miguel Regueiro, David Binion
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- Journal:
- Journal of Clinical and Translational Science / Volume 1 / Issue S1 / September 2017
- Published online by Cambridge University Press:
- 10 May 2018, p. 70
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- Article
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- Open access
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OBJECTIVES/SPECIFIC AIMS: Inflammatory bowel disease (IBD) patients are at an increased risk of Clostridium difficile infection (CDI) but the impact of CDI on disease severity is unclear. The aim of this study was to determine the effect of CDI on long-term disease outcome in a cohort of IBD patients. METHODS/STUDY POPULATION: We analyzed patients enrolled in a prospective IBD natural history registry. Patients who tested positive at least once formed the CDI positive group. We generated a 2:1 propensity matched control cohort based on risk factors of CDI in the year before infection. Healthcare utilization data (emergency department use, subsequent hospitalizations, telephone encounters), medications, labs, disease activity, and quality of life metrics were temporally organized. RESULTS/ANTICIPATED RESULTS: A total of 198 patients (66 CDI, 132 matched controls) were included [56.6% female; 60.1% Crohn’s disease (CD), 39.9% ulcerative colitis (UC)]. Groups were not significantly different in the year before infection in all metrics but in the year of infection, having CDI was significantly associated with more steroid and antibiotic exposure, elevated C-reactive protein or erythrocyte sedimentation rate, and low vitamin D (all p<0.01). Infection was associated with increased disease activity metrics (UC: p=0.036, CD: p=0.003), worse disease-related quality of life (p=0.003), and increased healthcare utilization (p<0.001). In the next year after infection those with prior CDI continued to have increased exposure to vancomycin or fidaxomicin (p<0.001) and all other antibiotics (p=0.01). They also continued to have more clinic visits (p=0.006), telephone encounters (p=0.001), and worse disease-related quality of life (p=0.03), but disease activity and biomarkers of severity were not significantly different between groups. DISCUSSION/SIGNIFICANCE OF IMPACT: CDI infection in IBD is significantly associated with various surrogate markers of disease severity, increased healthcare utilization and poor quality of life during the year of infection. CDI patients continue to experience poor quality of life after infection with increased clinic visits and antibiotic exposure while disease activity is no longer significantly increased. These findings suggest that CDI infection may have a lasting effect on healthcare utilization beyond the acute treatment period.
135 - Inflammatory Bowel Disease
- from PART III - VASCULAR BED/ORGAN STRUCTURE AND FUNCTION IN HEALTH AND DISEASE
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- By Ossama A. Hatoum, Froedtert Memorial Lutheran Hospital, Medical College of Wisconsin, Milwaukee, David G. Binion, Froedtert Memorial Lutheran Hospital, Medical College of Wisconsin, Milwaukee
- Edited by William C. Aird, Harvard University, Massachusetts
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- Book:
- Endothelial Biomedicine
- Published online:
- 04 May 2010
- Print publication:
- 03 September 2007, pp 1248-1254
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Summary
Human idiopathic inflammatory bowel disease (IBD), Crohn disease (CD) and ulcerative colitis (UC) are lifelong illnesses characterized by chronic inflammatory destruction of the gastrointestinal tract. IBD is estimated to affect between one to two million Americans, and is most commonly diagnosed during adolescence or early adulthood, thus representing a significant burden of disease throughout the patient's lifetime (1). The description of terminal ileitis in 1932, later commonly referred to as CD, distinguished chronic intestinal inflammation and stricture formation from intestinal tuberculosis (2), in which the resected gut tissues failed to demonstrate acid-fast bacilli on histological examination. The anatomic distribution of CD was later revised to include the large bowel (3, 4). Samuel Wilks initially described UC, distinguishing it from hemorrhagic bacterial dysentery by 1859. The first description of the natural history of UC was reported in 1909. Despite decades of intense research efforts, the etiology of IBD remains obscure and, as a result, treatment options are not specific and focus on blunting the chronic inflammatory process in the gut. A majority of CD patients ultimately require surgical intervention for complications, most commonly the emergence of symptomatic strictures in the intestinal lumen. Approximately one fourth of UC patients require colectomy for the treatment of medically refractory disease or the detection of neoplastic transformation, a well-recognized complication of long-standing chronic gut inflammation. Recent evidence from genetic and immunologic investigation has identified alterations in the innate immune response and inappropriate immune activation of the mucosal immune system in response to enteric microbiologic antigens as a potential inciting influence in the development of IBD.