Clostridioides (Clostridium) difficile infection. Review of current clinical guidelines

2020 ◽  
Vol 18 (6) ◽  
pp. 106-112
Author(s):  
I. V. NIKOLAEVA ◽  
◽  
S. V. KHALIULLINA ◽  
G. Kh. MURTAZINA ◽  
V. A. ANOKHIN ◽  
...  
Keyword(s):  
Causative Agent ◽  
Dynamic Assessment ◽  
Tube Feeding ◽  
Laboratory Research ◽  
Surgical Interventions ◽  
First Line Therapy ◽  
Clostridioides Difficile ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Immunodeficiency States

Clostridioides difficile (CDI) infection is a disease associated with a disruption of the gut microbiome with over-colonization of C. difficile, the toxins of which cause inflammation and damage to the colon. A dynamic assessment of the CDI prevalence indicates a significant increase in laboratory-confirmed cases of infection and a high mortality associated with it. C. difficile is recognized as the main causative agent of nosocomial infections in Europe, USA, Canada and Australia, which develops 48 hours after hospitalization in a medical facility and within 12 weeks after discharge. The severity of CDI is determined by the severity of infectious-toxic, diarrheal and abdominal syndromes. Severe CDI is characterized by manifestations of colitis, accompanied by severe leukocytosis, a decrease in albumin levels and an increase in serum creatinine levels. Development of fulminant forms, pseudomembranous colitis, toxic megacolon, intestinal perforation, sepsis is possible. The risk factors include in-hospital stay; recent use of antibiotics (within the previous 12 weeks, especially the use of fluoroquinolones, cephalosporins of III–IV generations, carbapenems and clindamycin), PPI and H2-histamine blockers; presence of inflammatory bowel diseases (ulcerative colitis, Crohn’s disease), immunodeficiency states, including iatrogenic; recent endoscopic examinations, surgical interventions on the gastrointestinal tract, tube feeding, enemas; possible contact with a family member who recently had a C..difficile infection. The «gold standard» for confirming the CDI diagnosis is the identification of the causative agent and/or toxins of C. difficile in the stool using specific laboratory research methods. Vancomycin or metronidazole are recommended as first-line therapy.

scholarly journals Small Molecule Drugs in Inflammatory Bowel Diseases

2021 ◽  
Vol 14 (7) ◽  
pp. 637
Author(s):  
Inès Ben Ghezala ◽  
Maëva Charkaoui ◽  
Christophe Michiels ◽  
Marc Bardou ◽  
Maxime Luu
Keyword(s):  
Inflammatory Bowel Diseases ◽  
Severe Disease ◽  
Standard Of Care ◽  
Mucosal Inflammation ◽  
Inadequate Response ◽  
First Line Therapy ◽  
Phosphodiesterase 4 Inhibitors ◽  
Bowel Diseases ◽  
Sphingosine 1 Phosphate ◽  
Inflammatory Bowel

Inflammatory bowel diseases (IBDs), mainly represented by Crohn’s disease (CD) and Ulcerative Colitis (UC), are chronic disorders with an unclear pathogenesis. This incurable and iterative intestinal mucosal inflammation requires the life-long use of anti-inflammatory drugs to prevent flares or relapses, which are the major providers of complications, such as small bowel strictures and intestinal perforations. The introduction of tumor necrosis factor (TNF)-alpha inhibitors and other compounds, such as anti-IL12/23 and anti-alpha4/beta7 integrin monoclonal antibodies, has considerably improved the clinical management of IBDs. They are now the standard of care, being the first-line therapy in patients with aggressive disease and in patients with moderate to severe disease with an inadequate response to conventional therapy. However, for approximately one third of all patients, their efficacy remains insufficient by a lack or loss of response due to the formation of anti-drug antibodies or compliance difficulties with parenteral formulations. To address these issues, orally administered Small Molecules Drugs (SMDs) that use a broad range of novel pharmacological pathways, such as JAK inhibitors, sphingosine-1-phosphate receptor modulators, and phosphodiesterase 4 inhibitors, have been developed for CD and UC. This article provides an updated and complete review of the most recently authorized SMDs and SMDs in phase II/III development.

scholarly journals Azathioprine with Allopurinol Is a Promising First-Line Therapy for Inflammatory Bowel Diseases

2021 ◽  
Author(s):  
Elsa L. S. A. van Liere ◽  
Ahmed B. Bayoumy ◽  
Chris J. J. Mulder ◽  
Ben Warner ◽  
Bu Hayee ◽  
...  
Keyword(s):  
Inflammatory Bowel Diseases ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Bowel Diseases ◽  
Inflammatory Bowel

scholarly journals Inflammatory Bowel Diseases: Focus on Therapy

2018 ◽  
Vol 24 (1) ◽  
pp. 9-14
Author(s):  
Tocia Cristina ◽  
Achim Anda Carmen ◽  
Alexandrescu Luana ◽  
Dumitru Eugen
Keyword(s):  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Inflammatory Bowel Diseases ◽  
Biologic Therapy ◽  
Immunosuppressive Drugs ◽  
Surgical Interventions ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Extraintestinal Complications

Abstract INTRODUCTION: Medical management of Inflammatory Bowel Diseases is complex and tailored to disease activity. The primary goal is the induction of remission and maintenance of remission with longterm prevention of disease progression. AIM: to describe current drug treatment practices in Inflammatory Bowel Diseases in Dobrogea. MATERIAL AND METHOD: The retrospective and descriptive study included 128 patients: group 1 = Crohn’s Disease (79), group 2 = Ulcerative Colitis (46) and group 3 = Unclassified Colitis (3). RESULTS: The phenotypic distribution was: 62% with Crohn’s Disease, 36% with Ulcerative Colitis and 3 patients with Unclassified Colitis. CROHN’S DISEASE: According to Montreal Classification, the majority of patients were diagnosed after 40 years (58%); the most frequent involvement was ileo-colonic (47%) and the most frequent phenotype was inflammatory (60%). 40% patients had intestinal complications and 7% had extraintestinal complications. 16.4% required surgical interventions. 67% were treated at some point with aminosalicylates, 44% with immunosuppressive drugs (thiopurines), 80% with corticosteroids for the induction of remission (inaugural flare) and 50% of them received again corticosteroidssteroids in the evolution of the disease, and 29% with biologic therapy. ULCERATIVE COLITIS: Most common location was left colitis in 47% cases. One patient had intestinal complications and no extraintestinal complications were reported in this group. No patients required surgical interventions. 82.5% were treated at some point with aminosalicylates, 37% with immunosuppressive drugs (thiopurines), 17% with corticosteroids and 11% with biologic therapy. UNCLASSIFIED COLITIS: In this group were not reported intestinal and extraintestinal complications and also no patient required surgical interventions. 2 patients were treated at some point with aminosalicylates, all patients were treated with immunomodulators and only one patient was administered biologic therapy. CONCLUSIONS: Particularities of Crohn’s Disease in our region are: widespread use of aminosalicylates, overuse of corticosteroids overtime, underprescribed biologic therapy.

The Juncture Between Clostridioides difficile Infection and Inflammatory Bowel Diseases

2019 ◽  
Vol 69 (2) ◽  
pp. 366-372 ◽  
Author(s):  
Poonam Beniwal-Patel ◽  
Daniel J Stein ◽  
L Silvia Munoz-Price
Keyword(s):  
Risk Factors ◽  
Inflammatory Bowel Disease ◽  
Abdominal Pain ◽  
Clinical Presentation ◽  
Common Occurrence ◽  
Clostridioides Difficile ◽  
Standard Clinical Practice ◽  
Bowel Diseases ◽  
Clostridioides Difficile Infection ◽  
Inflammatory Bowel

AbstractThe detection of Clostridioides difficile in inflammatory bowel disease (IBD) patients is a common occurrence, in part due to the standard clinical practice of testing for the presence of C. difficile during acute IBD exacerbations. Given the clinical overlap between C. difficile infections and acute IBD exacerbations (ie, increased frequency of loose stools, abdominal pain), it is hard to differentiate C. difficile infections versus colonizations in patients with underlying IBD who test positive for C. difficile. Here, we review the epidemiology, clinical presentation, risk factors, diagnosis, treatment, and outcomes of IBD patients with positive C. difficile tests.

scholarly journals Intestinal Organoids as a Novel Complementary Model to Dissect Inflammatory Bowel Disease

2019 ◽  
Vol 2019 ◽  
pp. 1-15 ◽  
Author(s):  
L. Schulte ◽  
M. Hohwieler ◽  
M. Müller ◽  
J. Klaus
Keyword(s):  
Intestinal Inflammation ◽  
Health Care Systems ◽  
Experimental Models ◽  
Intestinal Epithelial ◽  
Surgical Interventions ◽  
Relapsing Remitting ◽  
Bowel Diseases ◽  
Care Systems ◽  
Inflammatory Bowel

Inflammatory bowel diseases (IBDs) include colitis ulcerosa and Crohn’s disease, besides the rare microscopic colitis. Both diseases show a long-lasting, relapsing-remitting, or even chronic active course with tremendous impact on quality of life. IBDs frequently cause disability, surgical interventions, and high costs; as in other autoimmune diseases, their prevalent occurrence at an early phase of life raises the burden on health care systems. Unfortunately, our understanding of the pathogenesis is still incomplete and treatment therefore largely focuses on suppressing the resulting excessive inflammation. One obstacle for deciphering the causative processes is the scarcity of models that parallel the development of the disease, since intestinal inflammation is mostly induced artificially; moreover, the intestinal epithelium, which strongly contributes to IBD pathogenesis, is difficult to assess. Recently, the development of intestinal epithelial organoids has overcome many of those problems. Here, we give an overview on the current understanding of the pathogenesis of IBDs with reference to the limitations of previous well-established experimental models. We highlight the advantages and detriments of recent organoid-based experimental setups within the IBD field and suggest possible future applications.

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