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Published on: December 10, 2016
Bacterial Intestinal Superinfections in Inflammatory Bowel Diseases Beyond Clostridum difficile
Triana Lobatón1, Eugeni Domènech
1Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, CIBEREHD, Badalona, Spain.
Abstract:
Besides genetics and environmental factors, intestinal microbiota seem to play a major role in the pathogenesis of inflammatory bowel diseases. For many decades, it has been said that some enteropathogens may even trigger both inflammatory bowel disease development and disease flares. For this reason, stool testing had been performed in inflammatory bowel disease flares but current guidelines only recommend to rule out Clostridium difficile infection and there is no clear advice for other enteropathogens given that the scarce available evidence points at a low prevalence of this sort of intestinal superinfections with no clear impact on disease course. The present article reviews the current knowledge about the role of bacterial enteropathogens on disease pathogenesis and flares beyond C. difficile.
Insights
Investigating bacterial enteropathogens beyond Clostridium difficile in inflammatory bowel diseases (IBD) reveals their limited role in IBD pathogenesis and flares, despite historical beliefs. Current guidelines focus only on C. difficile, overlooking other potential triggers.
Area of Science:
- Gastroenterology
- Microbiology
- Immunology
Background:
- Intestinal microbiota significantly influence inflammatory bowel diseases (IBD) pathogenesis.
- Bacterial enteropathogens have been historically suspected of triggering IBD development and flares.
- Current IBD guidelines primarily recommend stool testing only for Clostridium difficile infection during flares.
Purpose of the Study:
- To review current knowledge on the role of bacterial enteropathogens in IBD pathogenesis.
- To evaluate the impact of enteropathogens, beyond C. difficile, on IBD disease flares.
- To assess the prevalence and clinical significance of non-C. difficile enteropathogen superinfections in IBD.
Main Methods:
- Literature review of existing studies on bacterial enteropathogens and IBD.
- Analysis of evidence regarding the prevalence of enteropathogen superinfections in IBD patients.
- Evaluation of the impact of identified enteropathogens on IBD disease course and flares.
Main Results:
- Available evidence suggests a low prevalence of intestinal superinfections with enteropathogens other than C. difficile in IBD patients.
- The impact of these superinfections on the overall IBD disease course and flare activity appears minimal.
- Current diagnostic and treatment guidelines for IBD flares do not extensively address non-C. difficile enteropathogens due to limited evidence.
Conclusions:
- Bacterial enteropathogens, excluding C. difficile, likely play a minor role in the pathogenesis and exacerbation of inflammatory bowel diseases.
- Further research may be needed to definitively clarify the role, if any, of specific enteropathogens in subsets of IBD patients.
- Focusing on C. difficile remains appropriate for routine stool testing in IBD flares based on current evidence.
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