Norovirus and E coli Common in IBD Patients

A recent study found that non-Clostridium difficile enteric infections are common among patients with inflammatory bowel diseases (IBD) and appear to play an important role in disease flares.

The researchers conducted a cross-sectional analysis using data from 9403 participants experiencing a diarrheal illness who underwent stool tests with a gastrointestinal pathogen PCR panel from March 2015 to March 2017. A total of 277 participants had Crohn disease (CD), 300 participants had ulcerative colitis (UC), and 8826 participants did not have IBD. The primary outcome included the presence of infection and secondary outcomes included endoscopic and histologic predictors of infection, as well as IBD outcomes after testing.
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“Non-Clostridium difficile enteric infections were identified in 17% of symptomatic participants with IBD,” the researchers said. However, participants with IBD were less likely to test positive for infection compared with participants without IBD (CD 18.1% and UC 16.1% vs no IBD 26.6%).

Compared with participants without IBD, participants with CD had a higher prevalence of norovirus and Campylobacter infections, while those with UC had a lower prevalence of norovirus infections but a higher prevalence of Campylobacter, Plesiomonas, and Escherichia coli species. Additionally, there were no major endoscopic or histologic predictors of a positive test among the 77 participants who underwent endoscopy.

While participants with IBD were more likely to have their therapy escalated after testing negative for infection, enteric infections did not impact IBD outcomes post-testing.

“Norovirus and E. coli may play an important role in flare of IBD,” the researchers concluded.

Axelrad JE, Joelson A, Green PHR, Lawlor G, et al. Enteric infections are common in patients with flares of inflammatory bowel disease [published online August 3, 2018]. Am J Gastroenterol. doi:10.1038/s41395-018-0211-8.