Lee Mi Rae, Kim Eun Soo
Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
Korean J Gastroenterol. 2022 Aug 25;80(2):66-71. doi: 10.4166/kjg.2022.097.
Inflammatory bowel disease (IBD), comprising Crohn's disease and ulcerative colitis, is a chronic inflammatory condition of the gastrointestinal tract, which is often accompanied by altered gut microbial composition. Gut dysbiosis in IBD is considered to be the reason for the high risk of infection (CDI) in patients with IBD. Therefore, CDI should be evaluated in IBD patients with a symptom flare. Medical treatment of non-severe CDI in IBD is similar to that in non-IBD patients and includes oral vancomycin or fidaxomicin. The risk of recurrent CDI in IBD is higher than in non-IBD patients and this could be mitigated by fecal microbiota transplantation. As CDI may worsen the clinical outcomes of IBD, patients should be carefully monitored and an escalation of IBD therapy needs to be considered when there is no improvement seen with the antimicrobial treatment of CDI. This review discusses the risk, pathophysiology, diagnosis, and management of CDI in IBD.
炎症性肠病（IBD）包括克罗恩病和溃疡性结肠炎，是一种胃肠道的慢性炎症性疾病，常伴有肠道微生物组成的改变。IBD中的肠道菌群失调被认为是IBD患者发生艰难梭菌感染（CDI）风险高的原因。因此，对于出现症状发作的IBD患者应评估是否存在CDI。IBD中非重症CDI的药物治疗与非IBD患者相似，包括口服万古霉素或非达霉素。IBD患者中CDI复发的风险高于非IBD患者，这可通过粪便微生物群移植来缓解。由于CDI可能会使IBD的临床结局恶化，因此应对患者进行仔细监测，并且当CDI抗菌治疗未见改善时，需要考虑加强IBD治疗。本综述讨论了IBD中CDI的风险、病理生理学、诊断和管理。
