Introduction Clinical features associated with infective diarrhoea and flare up of Inflammatory Bowel Disease (IBD) are very similar and presents a challenge to gastroenterologists to distinguish the two especially at the initial presentation.
Methods This was a retrospective cohort study for patients admitted to the gastroenterology department of a single tertiary care teaching hospital with a culture positive episode of bacterial infective diarrhoea, excluding Clostridium difficile. Data was collected from clinical notes of patients presenting over an 8 year period (2004–2012). We made comparisons between the cohorts of patients with and without IBD.
Results 103 patients were included in the study; 13 had pre-existing IBD (7 UC, 6 Crohn’s), mean age [52 (17 – 82) IBD, 41 (18 – 103) non- IBD]. Organisms cultured; IBD [campylobacter 84% (11), salmonella 16% (2)], non-IBD [campylobacter 81% (73), salmonella 12% (11), ecoli 4% (4), shigella 2% (2)]. Median duration of symptoms was similar in both groups [4 days (IQR 2) IBD, 4 (IQR 6) non-IBD]. Patient gave history of (IBD vs non IBD); abdominal pain [77 vs. 90% OR 0.37 (95% CI: 0.08–1.6)], per rectal bleeding [46 vs. 52% OR 0.78 (95% CI: 0.24–2.5)], vomiting [38% vs. 43% OR 0.81 (95% CI: 0.24–2.71)]. Blood tests showed (IBD vs non IBD); platelet count [median 282 (IQR 130) vs. 237 (IQR 90)], CRP [56 (IQR 81) vs. 82 (IQR 102)], haemoglobin concentration [median 12.1 (IQR 2.4) vs. 14.3 (IQR 2.6)] and white cell count [median 8 (IQR 4) vs. 7 (IQR 3)]. A much higher proportion of patients in IBD group received steroids [77 vs 16% OR 16.6 (95% CI: 4.0–61)]. Patients in both group had comparable duration of hospital stay [median 5 (IQR 4) vs. 4 (IQR 3)].
Conclusion Infective diarrhoea presents similarly in patients who have a background of IBD to those that don’t but is more likely to be treated with steroids. A short history with abdominal pain and vomiting suggest an infective cause should be considered even if there is a established diagnosis of IBD.
Disclosure of Interest None Declared.
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