Clostridioides difficile infection in inflammatory bowel disease: a clinical review

ABSTRACT

Introduction

Strong clinical data demonstrate that inflammatory bowel disease (IBD) is an independent risk factor for Clostridiodes difficile infection (CDI) and suggest a globally increased prevalence and severity of C. difficile coinfection in IBD patients (CDI-IBD). In addition to elderly individuals, children are also at higher risk of CDI-IBD. Rapid diagnosis is essential since the clinical manifestations of active IBD and CDI-IBD are indistinguishable. Antibiotics have been well established in the treatment of CDI-IBD, but they do not prevent recurrence.

Areas covered

Herein, the authors focus on reviewing recent research advances on the new therapies of CDI-IBD. The novel therapies include gut microbiota restoration therapies (such as prebiotics, probiotics and FMT), immunotherapy (such as vaccines and monoclonal antibodies) and diet strategies (such as groningen anti-inflammatory diet and mediterranean diet). Future extensive prospective and placebo-controlled studies are required to evaluate their efficacy and long-term safety.

Expert opinion

Available studies show that the prevalence of CDI-IBD is not optimistic. Currently, potential treatment options for CDI-IBD include a number of probiotics and novel antibiotics. This review updates the knowledge on the management of CDI in IBD patients, which is timely and important for GI doctors and scientists.

KEYWORDS:

• Antibody drugs
• clostridiodes difficile infection
• coinfection
• dietary therapy
• inflammatory bowel disease
• microbiome-based treatment

Article highlights

• IBD is an independent risk factor for CDI and the prevalence of CDI-IBD is not optimistic, particularly for young people.

• Antibiotics have been well established in the treatment of CDI-IBD, but they do not prevent recurrence due to antibiotic resistance.

• Novel microbiome-based therapies and immunotherapies are remain on the pre-clinical model stage, and more rigorous clinical trials are warranted to evaluate their efficacy and long-term safety.

• A growing number of preliminary studies suggest that dietary therapy is effective in patients with CDI-IBD. Future drugs use should be combined with dietary strategies to identify novel therapeutics.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contribution

All authors substantially contributed to the conception and design of the review article and interpreting the relevant literature and were involved in the writing the review article or revised it for intellectual content.

Additional information

Funding

This research was supported by National Natural Science Foundation of China [82002192], General Project of Natural Science Foundation of Hubei Province [2022CFB539], Young and Middle-aged Talents Project of Hubei Provincial Education Department [Q20222605] and Science and Technology Plan (in the field of Medical and health care) of Xiangyang [2022YL04B; 2022YL05B; 2022YL07B], Key Project of Xiangyang Central Hospital [2023YZ04].