الفهرس 
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Abstract
Clostridium difficile occurs in the faecal flora of humans. Sometimes, it causes infection leading to watery or bloody diarrhea, fever, abdominal cramping, and nausea due to the formation of toxin A and B. Some patients may suffer pseudomembranous colitis and severe infection may be fatal, especially in elderly people. Clostridium difficile infection is associated with prolonged use of antibiotics. It can mimic inflammatory bowel disease activity. Intestinal bacteria have an important role in the pathogenesis of inflammatory bowel disease. However, until now no certain organism or shift in composition of intestinal flora was proved to cause inflammatory bowel disease or its activity.
Aim of the study:
The aim of this study was to investigate the role of Clostridium difficile infection in patients with Crohn’s disease and ulcerative colitis in different stages of disease activity and the relation between Clostridium difficile infection and precipitating inflammatory bowel disease or its activity.
Subjects:
This study included twenty Crohn’s disease, twenty ulcerative colitis patients in different stages of activity, ten healthy control subjects. Subjects of different age and sex groups were selected randomly from inpatient and outpatient departments of the Main Alexandria University Hospital. Patients suffering indeterminate, atypical, infectious, ischemic, and drug induced colitis along with patients suffering diverticulitis and patients exposed to radiation therapy were excluded from the study.
Methods:
After written informed consents, all patients and control subjects were subjected to full history taking, complete clinical examination and laboratory investigations including, Complete blood picture, renal function tests, liver function tests, erythrocyte sedimentation rate (ESR), C- reactive protein (CRP), faecal calprotectin, perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA), Anti-Saccharomyces cerevisiae antibodies (ASCA). All patients were subjected to colonoscopy. Histopathological examination of biopsy samples taken from the lesions and colonic mucosa was done. Results were tabulated and statistical analysis of data was done.
Results:
There was no statistically significant difference neither between Crohn’s disease, ulcerative colitis, and control groups, nor between different stages of activity of both diseases, regarding Clostridium difficile toxin A&B in stool samples detected by ELISA.
There was one ulcerative colitis patient suffering Clostridium difficile infection. After receiving medical treatment, ELISA test for Clostridium difficile toxin A&B in stool sample changed to negative, and the patient improved from severe ulcerative colitis to mild disease according to Truelove-Witts severity classification of ulcerative colitis, and Mayo endoscopic score of ulcerative colitis two months after treatment. The endoscopy done for this patient did not show the CDI colitis characteristic pseudomembrane neither before or after treatment.
There was a positive correlation between clinical and endoscopic disease activity in both ulcerative colitis and Crohn’s disease patients.
Anemia was found to be a common complication of both Crohn’s disease and ulcerative colitis, with no significant difference between the two diseases. There was a positive correlation between leukocytosis and disease severity.
Serum albumin was lower in ulcerative colitis patients than in control subjects while there was no statistically significant difference between Crohn’s disease patients and control subjects. There was no statistically significant difference between total serum protein level in ulcerative colitis patients, Crohn’s disease patients, and control subjects.
There was no statistically significant difference between different stages of disease severity regarding serum albumin or total serum protein in ulcerative colitis patients. There was a negative correlation between serum albumin and disease severity in Crohn’s disease patients.
Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were higher in both Crohn’s disease patients and ulcerative colitis patients than in control subjects with no statistically significant difference between ulcerative colitis and Crohn’s disease groups.
Erythrocyte sedimentation rate (ESR) positively correlated to disease severity in ulcerative colitis patients, while it did not show the same correlation in Crohn’s disease patients. C-reactive protein (CRP) positively correlated to disease severity in both ulcerative colitis and Crohn’s disease patients. This indicates that CRP is a better indicator of disease activity than ESR in Crohn’s disease.
Faecal calprotectin was higher in both Crohn’s disease patients and ulcerative colitis patients than in control subjects with no statistically significant difference between ulcerative colitis and Crohn’s disease groups. Faecal calprotectin positively correlated to clinical and endoscopic disease severity in both ulcerative colitis and Crohn’s disease patients.
P-ANCA was mostly positive in ulcerative colitis patients, ASCA was mostly positive in Crohn’s disease patients, and both were negative in all control subjects, showing a statistically significant difference between the three groups. Both were not correlated to either disease activity.
Conclusion:
from the present study one can conclude that, Clostridium difficile infection may aggravate the inflammatory bowel disease patient’s condition. Thus, should be considered in patients recently diagnosed as IBD, and patients who suffer acutely worsening IBD condition. IBD clinical and endoscopic activity in patients who suffer concurrent Clostridium diffici