Retrospective evaluation of demographic-clinical characteristics and treatment response in patients diagnosed with amebic colitis, C. difficile infection or CMV colitis during follow-up for inflammatory bowel diseases

Objective: Due to both disruption of the mucosal barrier and use of immunosuppressive agents, the risk of infectious colitis is increased in patients with inflammatory bowel disease (IBD). In our study, we aimed to evaluate the demographic and clinical characteristics, laboratory tests, treatment modalities and response to therapy in patients with IBD, who were diagnosed with amebic colitis, clostridium difficile infection (CDI) or cytomegalovirus (CMV) colitis during their disease course. Material and Method: Totally 261 patients, 170 of whom were diagnosed with ulcerative colitis (UC) and 90 with Crohn's disease (CD), who admitted to Karadeniz Technical University, Faculty of Medicine, Gastroenterology Clinic and followed up for at least 1 year, were enrolled to our study. Patient data were retrospectively scanned for age, gender, blood group, personal history of chronic diseases and operations, smoking-alcohol use, family history, drug use, duration and the clinical characteristics of the disease, symptom sand laboratory test results before treatment and during follow-up. Results: The number of IBD patients who had no infection was 184 (70.5%), 52 (20%) for amebic colitis, 6 (2.3%) for CMV colitis, and 7 (2.7%) for CDI. The mean age at diagnosis of non-infected patients was lower than those with infection (36.64 ± 14.91 years vs 38.16 ± 15.33 years, p<0.001). Most of the infected IBD patients were diagnosed with UC rather than CD and the difference was statistically significant (91% UC and 9% CD; p<0.001). Leukopenia, lymphopenia, anemia, erythrocyte sedimentation rate (ESH) and C-reactive protein (CRP) elevation were detected more frequently in patients with CMV colitis. Failure to achieve remission, symptomatic exacerbation and relapse rates were statistically significantly higher in patients with any infection compared to patients with no history of infection (p<0.001, p<0.001 and p<0.001, respectively). Similarly, remission failure, symptomatic exacerbation and relapse rates were statistically significantly higher in patients with amebic colitis than in patients with no infection (p<0.001, p<0.001 and p<0.001, respectively). Conclusion: Infections, especially amebic colitis, are frequently observed in patients with IBD, more prominently in patients with UC. Failure to achieve remission, symptomatic exacerbation and relapse were found more frequently in patients with infection. For this reason, infectious causes should be kept in mind, especially in IBD cases presenting with exacerbation, and should be treated as soon as possible by making an early diagnosis. Key Words: Inflammatory Bowel Disease, Ulcerative Colitis, Crohn's Disease, CMV Colitis, Amebic Colitis, Clostridium Difficile Infection