Clostridium difficile in Crohn's disease

Clostridium difficile has been detected in the stools of some patients with relapse of Crohn's disease. The authors looked prospectively for present or previous exposure to C. difficile cytotoxin in 10 patients with mild to severe Crohn's disease. None of 25 stool samples from these 10 patients was positive for C. difficile cytotoxin. These negative stool ultrafiltrates had mild cytotoxin neutralizing activity, but this finding did not differ from that in 30 cytotoxin-negative stools from patients with other diarrheal diseases. Serum from these patients also showed no cytotoxin neutralizing activity. Review of the literature reveals that C. difficile can cause complications ranging from diarrhea to toxic megacolon in a small but variable proportion of patients with Crohn's disease. There is no evidence that C. difficile plays a part in the pathogenesis of the disease.