Practice of gastroenterologists in treating flaring inflammatory bowel disease patients with clostridium difficile: antibiotics alone or combined antibiotics/immunomodulators?

Abstract:

BACKGROUND:The optimal management of Clostridium difficile infection (CDI) in flaring inflammatory bowel disease (IBD) patients has not been defined. Limited data suggest that coadministration of immunomodulators (IM) with antibiotics (AB) results in a worse outcome. We investigated the prevalent practice among North American gastroenterologists in this scenario. METHODS:A structured questionnaire presented the clinical cases of two hospitalized patients with ulcerative colitis and concomitant CDI, either with or without prior IM treatment. The questionnaire was distributed to a sample of gastroenterologists at medical centers across North America. Respondents were requested to denote their therapeutic choices for these patients. RESULTS:The survey included 169 gastroenterologists, 122 from the US and 47 from Canada, with an average of 12 ± 10 years of experience in gastroenterology. Forty-two (25%) of the respondents were IBD experts. Seventy-seven (46%) respondents elected to add an IM in combination with AB, whereas 82/169 (54%) treated the flare with AB alone (P = NS). The rate of administering combined AB+IM was similar for the IBD experts and the non-IBD experts. Only 11% of respondents withdrew maintenance azathioprine upon the diagnosis of CDI. More IBD experts stopped azathioprine treatment compared to the non-IBD experts (12/42 versus 6/127, P < 0.001). Overall, 65% of surveyed gastroenterologists stated they believe these patients are afflicted by two simultaneous but separate disease processes. CONCLUSIONS:There is significant disagreement among gastroenterologists on whether combination AB+IM or AB alone should be given to IBD patients with CDI-associated flares. Controlled trials are needed to investigate the optimal management approach to this clinical dilemma.

journal_name

Inflamm Bowel Dis

authors

Yanai H,Nguyen GC,Yun L,Lebwohl O,Navaneethan U,Stone CD,Ghazi L,Moayyedi P,Brooks J,Bernstein CN,Ben-Horin S

doi

10.1002/ibd.21514

subject

Has Abstract

pub_date

2011-07-01 00:00:00

pages

1540-6

issue

7

eissn

1078-0998

issn

1536-4844

journal_volume

17

pub_type

杂志文章
  • Treatment patterns, complications, and disease relapse in a real-world population of patients with moderate-to-severe ulcerative colitis initiating immunomodulator therapy.

    abstract:BACKGROUND:Immunomodulator (IM) treatments in ulcerative colitis (UC) are not curative and carry increased risk of complications, sometimes leading to therapy changes, reduced treatment benefits, and eventual relapse. We assessed patterns of IM utilization and therapy changes, complications, and disease relapse in a re...

    journal_title:Inflammatory bowel diseases

    pub_type: 杂志文章

    doi:10.1097/MIB.0000000000000089

    authors: Loftus EV Jr,Davis KL,Wang CC,Dastani H,Luo A

    更新日期:2014-08-01 00:00:00

  • Anti-TNF-α Use During the Third Trimester of Pregnancy in Women with Moderate-severe Inflammatory Bowel Disease and the Risk of Preterm Birth and Low Birth Weight.

    abstract:BACKGROUND:Little knowledge exists about the association between anti-tumor necrosis factor-alpha (anti-TNF-α) therapy for inflammatory bowel disease during late pregnancy and adverse birth outcomes. We aimed to examine whether treatment with anti-TNF-α during the third trimester affected preterm birth and low birth we...

    journal_title:Inflammatory bowel diseases

    pub_type: 杂志文章

    doi:10.1097/MIB.0000000000001234

    authors: Kammerlander H,Nielsen J,Knudsen T,Kjeldsen J,Friedman S,Nørgård BM

    更新日期:2017-11-01 00:00:00

  • Diagnostic Accuracy of Blood-Based Tests and Histopathology for Cytomegalovirus Reactivation in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis.

    abstract:BACKGROUND:It is unclear if traditional histopathology and noninvasive blood-based tests are sufficiently accurate to detect cytomegalovirus (CMV) reactivation in inflammatory bowel disease. Therefore, we assessed the diagnostic accuracy of these tests compared with immunohistochemistry (IHC) and tissue polymerase chai...

    journal_title:Inflammatory bowel diseases

    pub_type: 杂志文章,meta分析,评审

    doi:10.1097/MIB.0000000000001073

    authors: Tandon P,James P,Cordeiro E,Mallick R,Shukla T,McCurdy JD

    更新日期:2017-04-01 00:00:00

  • Health-related quality of life improves in children and adolescents with inflammatory bowel disease after attending a camp sponsored by the Crohn's and Colitis Foundation of America.

    abstract:PURPOSE:To describe the reported health-related quality of life (HRQOL) in children and adolescents with inflammatory bowel disease (IBD) after attending an IBD summer camp. METHODS:A prospective analysis of quality of life was completed at an overnight camp that was exclusively for patients with IBD, which was sponso...

    journal_title:Inflammatory bowel diseases

    pub_type: 杂志文章

    doi:10.1097/00054725-200502000-00010

    authors: Shepanski MA,Hurd LB,Culton K,Markowitz JE,Mamula P,Baldassano RN

    更新日期:2005-02-01 00:00:00

  • Bacterial Mucosa-associated Microbiome in Inflamed and Proximal Noninflamed Ileum of Patients With Crohn's Disease.

    abstract:BACKGROUND:Microbiota is most likely essential in the pathogenesis of Crohn's disease (CD). Fecal diversion after ileocecal resection (ICR) protects against CD recurrence, whereas infusion of fecal content triggers inflammation. After ICR, the majority of patients experience endoscopic recurrence in the neoterminal ile...

    journal_title:Inflammatory bowel diseases

    pub_type: 杂志文章

    doi:10.1093/ibd/izaa107

    authors: Olaisen M,Flatberg A,Granlund AVB,Røyset ES,Martinsen TC,Sandvik AK,Fossmark R

    更新日期:2021-01-01 00:00:00

  • Providing disease-related information worsens health-related quality of life in inflammatory bowel disease.

    abstract:BACKGROUND:Patients with inflammatory bowel disease (IBD) have identified a need for more information about their disease. PURPOSE:To assess the effect of an educational intervention on health-related quality of life (HRQOL) in patients with IBD. METHODS:Consecutive ambulatory IBD patients were randomized to receive ...

    journal_title:Inflammatory bowel diseases

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00054725-200207000-00005

    authors: Borgaonkar MR,Townson G,Donnelly M,Irvine EJ

    更新日期:2002-07-01 00:00:00

  • Serological antibodies in inflammatory bowel disease: a systematic review.

    abstract::The diagnosis of inflammatory bowel disease (IBD) is traditionally based on a combination of clinical, endoscopic, histological, and radiological criteria. However, further testing is needed in cases of diagnostic uncertainty and in predicting disease course. This systematic review focuses on the potential for 10 sero...

    journal_title:Inflammatory bowel diseases

    pub_type: 杂志文章,评审

    doi:10.1002/ibd.21903

    authors: Prideaux L,De Cruz P,Ng SC,Kamm MA

    更新日期:2012-07-01 00:00:00

  • The case for using 5-aminosalicyclates in Crohn's disease: pro.

    abstract::Mesalamine has a well-established role in the management of ulcerative colitis. However, its role in the management of Crohn's disease (CD) is less clear. Studies evaluating its therapeutic value in CD have produced both positive and negative results. Meta-analyses have not clarified the situation, possibly because th...

    journal_title:Inflammatory bowel diseases

    pub_type: 评论,社论

    doi:10.1097/01.mib.0000160743.24772.69

    authors: Hanauer SB

    更新日期:2005-06-01 00:00:00

  • Multidimensional Impact of Mediterranean Diet on IBD Patients.

    abstract:BACKGROUND & AIMS:Malnutrition with the accumulation of fat tissue and nonalcoholic fatty liver disease (NAFLD) are conditions associated with inflammatory bowel disease (IBD). Visceral fat and NAFLD-related liver dysfunction can both worsen intestinal inflammation. Because the Mediterranean diet (Md) has been shown to...

    journal_title:Inflammatory bowel diseases

    pub_type: 杂志文章

    doi:10.1093/ibd/izaa097

    authors: Chicco F,Magrì S,Cingolani A,Paduano D,Pesenti M,Zara F,Tumbarello F,Urru E,Melis A,Casula L,Fantini MC,Usai P

    更新日期:2021-01-01 00:00:00

  • Intestinal interleukin-13 in pediatric inflammatory bowel disease patients.

    abstract:BACKGROUND:Interleukin-13 (IL-13) is a multifunctional cytokine whose net principle action is to diminish inflammatory responses. Dysregulation of IL-13 production has been proposed to contribute to intestinal inflammation in inflammatory bowel disease (IBD) patients. Previous studies implicate IL-13 in IBD pathogenesi...

    journal_title:Inflammatory bowel diseases

    pub_type: 杂志文章

    doi:10.1097/00054725-200409000-00014

    authors: Kadivar K,Ruchelli ED,Markowitz JE,Defelice ML,Strogatz ML,Kanzaria MM,Reddy KP,Baldassano RN,von Allmen D,Brown KA

    更新日期:2004-09-01 00:00:00

  • Validation of the mainland Chinese version of the Inflammatory Bowel Disease Questionnaire (IBDQ) for ulcerative colitis and Crohn's disease.

    abstract:BACKGROUND:Inflammatory bowel disease affects the quality of a patient's life in many ways, but no validated instrument for measuring disease-specific quality of life in these patients is available for use in Mainland China. The aim of our study was to develop and validate the Mainland Chinese translation of the Inflam...

    journal_title:Inflammatory bowel diseases

    pub_type: 杂志文章

    doi:10.1002/ibd.20128

    authors: Ren WH,Lai M,Chen Y,Irvine EJ,Zhou YX

    更新日期:2007-07-01 00:00:00

  • Risk factors and outcome of PCR-detected Clostridium difficile infection in ileal pouch patients.

    abstract:BACKGROUND:The clinical implication of Clostridium difficile infection (CDI) in patients with ileal pouch-anal anastomosis (IPAA) for underlying inflammatory bowel disease (IBD) has not been well studied. This study was designed to investigate the cumulative incidence, risk factors, and outcome of CDI in patients with ...

    journal_title:Inflammatory bowel diseases

    pub_type: 临床试验,杂志文章

    doi:10.1097/MIB.0b013e318280fcb9

    authors: Li Y,Qian J,Queener E,Shen B

    更新日期:2013-02-01 00:00:00

  • Multi-Center Experience of Vedolizumab Effectiveness in Pediatric Inflammatory Bowel Disease.

    abstract:BACKGROUND:Though vedolizumab has received regulatory approval for the treatment of Crohn's disease (CD) and ulcerative colitis (UC) in adults, there is increasing off-label use in children. AIMS:To describe the experience with vedolizumab in pediatric inflammatory bowel disease (IBD) patients at 3 tertiary IBD center...

    journal_title:Inflammatory bowel diseases

    pub_type: 杂志文章,多中心研究

    doi:10.1097/MIB.0000000000000865

    authors: Singh N,Rabizadeh S,Jossen J,Pittman N,Check M,Hashemi G,Phan BL,Hyams JS,Dubinsky MC

    更新日期:2016-09-01 00:00:00

  • Chromoendoscopy versus narrow band imaging for colonic surveillance in inflammatory bowel disease.

    abstract:BACKGROUND:Mucosal dye spraying (chromoendoscopy [CE]) has been shown in controlled studies to enhance lesion detection in colitis surveillance. Narrow band imaging (NBI) potentially offers a more convenient mode of highlighting mucosal lesions. The primary objectives of this study were to compare CE and NBI in colitis...

    journal_title:Inflammatory bowel diseases

    pub_type: 杂志文章

    doi:10.1097/MIB.0b013e31829637b9

    authors: Efthymiou M,Allen PB,Taylor AC,Desmond PV,Jayasakera C,De Cruz P,Kamm MA

    更新日期:2013-09-01 00:00:00

  • The Role of Citrullination in Inflammatory Bowel Disease: A Neglected Player in Triggering Inflammation and Fibrosis?

    abstract::Citrullination is a posttranslational modification of proteins mediated by a specific family of enzymes called peptidylarginine deiminases (PAD). Dysregulation of these enzymes is involved in the etiology of various diseases, from cancer to autoimmune disorders. In inflammatory bowel disease (IBD), data for a role of ...

    journal_title:Inflammatory bowel diseases

    pub_type: 杂志文章

    doi:10.1093/ibd/izaa095

    authors: Dragoni G,De Hertogh G,Vermeire S

    更新日期:2021-01-01 00:00:00

  • Vaccinating the inflammatory bowel disease patient: deficiencies in gastroenterologists knowledge.

    abstract:BACKGROUND:Current therapy for inflammatory bowel disease (IBD) patients often involves agents that suppress the immune system, placing patients at an increased risk for developing infections, of which several are potentially vaccine preventable. Many IBD patients are not being vaccinated appropriately. The aims of thi...

    journal_title:Inflammatory bowel diseases

    pub_type: 杂志文章,随机对照试验

    doi:10.1002/ibd.21667

    authors: Wasan SK,Coukos JA,Farraye FA

    更新日期:2011-12-01 00:00:00

  • Gliotoxin reduces the severity of trinitrobenzene sulfonic acid-induced colitis in mice: evidence of the connection between heme oxygenase-1 and the nuclear factor-kappaB pathway in vitro and in vivo.

    abstract:BACKGROUND:Gliotoxin, a fungal metabolite, has been known to show strong immunosuppressive properties, although its mechanisms are not completely understood. In this report, the authors investigated the mechanism whereby gliotoxin has anti-inflammatory properties in vitro and in trinitrobenzene sulfonic acid-induced co...

    journal_title:Inflammatory bowel diseases

    pub_type: 杂志文章

    doi:10.1097/01.ibd.0000225340.99108.8a

    authors: Jun CD,Kim Y,Choi EY,Kim M,Park B,Youn B,Yu K,Choi KS,Yoon KH,Choi SC,Lee MS,Park KI,Choi M,Chung Y,Oh J

    更新日期:2006-07-01 00:00:00

  • Antiviral Therapy in Steroid-refractory Ulcerative Colitis with Cytomegalovirus: Systematic Review and Meta-analysis.

    abstract:BACKGROUND:The role of antiviral therapy in patients with ulcerative colitis (UC) with cytomegalovirus (CMV) remains unclear. We therefore performed a systematic review and meta-analysis to assess the association between antiviral therapy and the risk of colectomy. METHODS:Multiple electronic databases were searched s...

    journal_title:Inflammatory bowel diseases

    pub_type: 杂志文章,meta分析,评审

    doi:10.1097/MIB.0000000000000489

    authors: Shukla T,Singh S,Loftus EV Jr,Bruining DH,McCurdy JD

    更新日期:2015-11-01 00:00:00

  • Intra- and interobserver variation in the use of the Vienna classification of Crohn's disease.

    abstract:BACKGROUND:Crohn's disease is a heterogeneous disease, and several classification systems have been developed to classify the patients in more homogeneous groups. Our aim was to assess the intra- and interobserver variation when classifying patients according to the widely used Vifenna classification. METHODS:Ten rand...

    journal_title:Inflammatory bowel diseases

    pub_type: 杂志文章

    doi:10.1097/01.mib.0000165115.18310.e7

    authors: Riis L,Munkholm P,Binder V,Skovgaard LT,Langholz E

    更新日期:2005-07-01 00:00:00

  • Development and Validation of a Confocal Laser Endomicroscopy-Based Score for In Vivo Assessment of Mucosal Healing in Ulcerative Colitis Patients.

    abstract:Background:Endoscopic monitoring is fundamental for evaluating the therapeutic response in IBD, but a validated endomicroscopic mucosal healing (MH) score is not available to date. However, confocal laser endomicroscopy (CLE) might define MH more precisely than conventional endoscopy. The major aim was to establish and...

    journal_title:Inflammatory bowel diseases

    pub_type: 杂志文章

    doi:10.1093/ibd/izx012

    authors: Hundorfean G,Chiriac MT,Mihai S,Hartmann A,Mudter J,Neurath MF

    更新日期:2017-12-19 00:00:00

  • Comparative Evaluation of Conventional Stool Testing and Multiplex Molecular Panel in Outpatients With Relapse of Inflammatory Bowel Disease.

    abstract:BACKGROUND:Differentiating between enteric infection and relapse of inflammatory bowel disease (IBD) is a common clinical challenge. Few studies have evaluated the impact of multiplex gastrointestinal polymerase chain reaction (GI PCR) pathogen panels on clinical practice compared to stool culture. Our aim was to compa...

    journal_title:Inflammatory bowel diseases

    pub_type: 杂志文章

    doi:10.1093/ibd/izaa336

    authors: Hong S,Zaki TA,Main M,Hine AM,Chang S,Hudesman D,Axelrad JE

    更新日期:2021-01-02 00:00:00

  • Targeted inhibition of heat shock protein 90 suppresses tumor necrosis factor-α and ameliorates murine intestinal inflammation.

    abstract::Inflammatory bowel diseases are chronic intestinal inflammatory diseases thought to reflect a dysregulated immune response. Although antibody-based inhibition of tumor necrosis factor-α (TNF-α) has provided relief to many inflammatory bowel diseases patients, these therapies are either ineffective in a patient subset ...

    journal_title:Inflammatory bowel diseases

    pub_type: 杂志文章

    doi:10.1097/01.MIB.0000442839.28664.75

    authors: Collins CB,Strassheim D,Aherne CM,Yeckes AR,Jedlicka P,de Zoeten EF

    更新日期:2014-04-01 00:00:00

  • The IBD-F Patient Self-Assessment Scale Accurately Depicts the Level of Fatigue and Predicts a Negative Effect on the Quality of Life of Patients With IBD in Clinical Remission.

    abstract:BACKGROUND:Fatigue is highly prevalent among patients with inflammatory bowel disease (IBD) and may have an unfavorable impact on quality of life (QoL). The IBD-Fatigue scale (with components SCORE1 and SCORE2) is a recently developed disease-specific questionnaire. We sought to validate a Greek version of IBD-F and us...

    journal_title:Inflammatory bowel diseases

    pub_type: 杂志文章

    doi:10.1093/ibd/izaa201

    authors: Varbobitis I,Kokkotis G,Gizis M,Perlepe N,Laoudi E,Bletsa M,Bekiari D,Koutsounas I,Kounadis G,Xourafas V,Lagou S,Kolios G,Papakonstantinou I,Bamias G

    更新日期:2020-08-07 00:00:00

  • The Management of Intestinal Penetrating Crohn's Disease.

    abstract::Crohn's disease (CD) leads to the development of complications through progressive uncontrolled inflammation and the transmural involvement of the bowel wall. Most of the available literature on penetrating CD focuses on the perianal phenotype. The management of nonperianal penetrating complications poses its own set ...

    journal_title:Inflammatory bowel diseases

    pub_type: 杂志文章,评审

    doi:10.1093/ibd/izx108

    authors: Hirten RP,Shah S,Sachar DB,Colombel JF

    更新日期:2018-03-19 00:00:00

  • Quantification and characterization of mucosa-associated and intracellular Escherichia coli in inflammatory bowel disease.

    abstract:BACKGROUND:Mucosa-associated Escherichia coli are abundant in inflammatory bowel disease (IBD), but whether these bacteria gain intracellular access within the mucosa is uncertain. If E. coli does gain intracellular access, the contribution of bacterial pathogenicity to this requires further elucidation. This study aim...

    journal_title:Inflammatory bowel diseases

    pub_type: 杂志文章

    doi:10.1097/MIB.0b013e3182a38a92

    authors: Elliott TR,Hudspith BN,Wu G,Cooley M,Parkes G,Quiñones B,Randall L,Mandrell RE,Fagerquist CK,Brostoff J,Rayment NB,Boussioutas A,Petrovska L,Sanderson JD

    更新日期:2013-10-01 00:00:00

  • Immunoregulatory Pathways Involved in Inflammatory Bowel Disease.

    abstract::Inflammatory bowel diseases (IBD) include ulcerative colitis and Crohn's disease. The immune response in ulcerative colitis is different from the Crohn's disease. Accumulating evidence suggests that IBD results from an inappropriate inflammatory response to intestinal microbes in a genetically susceptible host. Severa...

    journal_title:Inflammatory bowel diseases

    pub_type: 杂志文章,评审

    doi:10.1097/MIB.0000000000000477

    authors: Fonseca-Camarillo G,Yamamoto-Furusho JK

    更新日期:2015-09-01 00:00:00

  • Interleukin 23 in Crohn's disease.

    abstract::: Crohn's disease (CD) is a lifelong inflammatory condition with underlying environmental and genetic components. CD affects multiple parts of the gastrointestinal tract, and it has a growing incidence in Western societies. IL-23 receptor variants have been identified as susceptibility or resistance factors for CD in ...

    journal_title:Inflammatory bowel diseases

    pub_type: 杂志文章,评审

    doi:10.1097/01.MIB.0000442014.52661.20

    authors: Eken A,Singh AK,Oukka M

    更新日期:2014-03-01 00:00:00

  • High Patient Activation Is Associated With Remission in Patients With Inflammatory Bowel Disease.

    abstract:BACKGROUND:High levels of patient activation (having the knowledge, skills, and confidence to effectively manage one's care), have been associated with improved outcomes in many chronic conditions. There have been few studies of the effects of activation in patients with inflammatory bowel disease (IBD). We performed a...

    journal_title:Inflammatory bowel diseases

    pub_type: 杂志文章

    doi:10.1093/ibd/izy378

    authors: Barnes EL,Long MD,Kappelman MD,Martin CF,Sandler RS

    更新日期:2019-06-18 00:00:00

  • Fecal excretion of deoxyribonucleic acid in long-term follow-up of patients with inactive ulcerative colitis.

    abstract:BACKGROUND:We have developed a technique for measuring fecal excretion of human DNA by assuming that luminal desquamation of epithelial and inflammatory cells increases in damaged colonic mucosa. However, the clinical usefulness of this technique in the follow-up of patients with ulcerative colitis has not been establi...

    journal_title:Inflammatory bowel diseases

    pub_type: 杂志文章

    doi:10.1002/ibd.20042

    authors: Casellas F,Borruel N,Antolín M,Varela E,Torrejón A,Armadans L,Guarner F,Malagelada JR

    更新日期:2007-04-01 00:00:00

  • Immune System Activation in C3H/HeJBir Mice Exhibiting Spontaneous Perianal Ulceration.

    abstract::: We report our initial characterization of the immune system in C3H/HeJBir mice that spontaneously develop perianal ulceration. Analysis of lymphokine production by mucosal and systemic lymphoid cells obtained from these mice revealed higher levels of interleukin (IL)4 in supernatants of in vitro stimulated Peyer's p...

    journal_title:Inflammatory bowel diseases

    pub_type: 杂志文章

    doi:

    authors: Tonkonogy SL,Sartor BR

    更新日期:1997-04-01 00:00:00