This abstract of a new study indicates increasing incidence of an association between IBD and C. difficile. It does not clearly implicate it as a cause of IBD, but stresses the possibility of C. difficile infection as causing a worsening of the IBD disease course. Plus, it also verifies the incidence of small bowel C. difficile infection (once thought not possible), particularly in those who had prior colectomy. It suggests that C. difficile infection should be considered in the presence of chronic or relasping pouchitis that is resistant to standard treatment.
http://www.ncbi.nlm.nih.gov/pubmed/18473400?ordinalpos=...anel.Pubmed_RVDocSum

Here is another link that stresses the consideration of C. difficile infection in those with IBD who flare and are deteriorating on steroids. With the more virulent strains out there, Flagyl is becoming less and less effective.
http://www.ncbi.nlm.nih.gov/pubmed/18484669?ordinalpos=...les&logdbfrom=pubmed

Jan

Thank you for the information. It certainly is something to keep in mind as I deal with pouchitis. I am off antibiotics as of yesterday and am really pushing VSL#3 DS to see if I can keep the pouchitis away. I am hopeful.

Not that there ever was any question of an association in my mind, even though there has been scant reserach. Neither of these articles seem to address the question of "which came first" however, especially if a c. diff infection preceeds the IBD diagnosis.

Obviously, if the infection precedes the UC, it undoubtedly was first, and certainly seemed to be the triggering agent. It is noted in many articles that a variety of triggering agents are possible, including the typical normal flora of the gut. There have been quite a few references in the literature of UC manifesting following an infection of the colon.

What I found interesting in these articles is the affirmation that not only is C. diff infection possible following colectomy, it should be on the table in the differential diagnosis of pouchitis or ileitis, this I think especially before jumping to the Crohn's conclusion.

Jan

The reason the question of which came first is of interest to me is that Thomas' first c. diff infection was not antibiotic associated, nor had he been in a hospital or nursing home (unless you consider a cruise ship a nursing home, which isn't so far-fetched). So why did he get it, if not for some kind of compromised situation in the colon?--in which case, maybe IBD actually came first, even though there were no symptoms or dx. In any event, it has always seemed apparent to me that there is some kind of association that merits more study.

This is very interesting. I was tested for c-diff in Feb. in the hospital. It was negative. Should I be tested again since I am still dealing with pouchitis?

Often, multiple tests are required before a positive finding. Some docs go on the assumption of C. diff and treat, assuming the test was a false negative.

Jan