Clostridium difficile infection in patients with ileal pouch-anal anastomosis

Clin Gastroenterol Hepatol. 2008 Jul;6(7):782-8. doi: 10.1016/j.cgh.2008.02.021. Epub 2008 May 7.


Background & aims: There has been an increase in the incidence and severity of Clostridium difficile-associated diarrhea in the U.S. The importance of C difficile infection in patients with ileal pouch-anal anastomosis (IPAA) is unknown. This study was designed to determine risk of acquiring C difficile infection in pouch disorders.

Methods: Consecutive ulcerative colitis patients (n = 115) with IPAA undergoing pouch endoscopy were enrolled from May 2005-March 2006. Fecal specimens of pouch aspirate were collected during pouch endoscopy and analyzed for C difficile toxin A and B by enzyme-linked immunosorbent assay. Nineteen clinical, endoscopic, and histologic variables were assessed with stepwise selection methods. Two multivariate logistic regression models were constructed.

Results: Twenty-one patients (18.3%) were positive for C difficile infection. Adjusting for other factors in the model, men were 5.12 (95% confidence interval, 1.38-20.46) times more likely to have C difficile infection than women. Compared with patients with pancolitis, those with preoperative left-sided colitis were 8.4 (95% confidence interval, 1.25-56.4) times more likely to have C difficile infection. Six of 6 patients with C difficile infection (3 with refractory pouchitis, 2 with Crohn's disease, and 1 with irritable pouch syndrome) with repeat clinical, endoscopic, and laboratory evaluation after anti-C difficile therapy experienced clinical remission and disappearance of C difficile toxin from stools, with 4 showing decreased mucosal inflammation.

Conclusions: C difficile infection involving IPAA is common, characteristically occurring with or without previous receipt of antibiotics. Treatment of C difficile infection in patients with IPAA might improve the clinical outcome.

MeSH terms

  • Adult
  • Anal Canal*
  • Anastomosis, Surgical / adverse effects*
  • Bacterial Proteins / analysis
  • Bacterial Toxins / analysis
  • Clostridioides difficile / isolation & purification*
  • Colitis, Ulcerative / complications*
  • Colitis, Ulcerative / surgery*
  • Colonic Pouches*
  • Diarrhea / microbiology
  • Enterocolitis, Pseudomembranous / diagnosis
  • Enterocolitis, Pseudomembranous / epidemiology*
  • Enterotoxins / analysis
  • Enzyme-Linked Immunosorbent Assay
  • Feces / chemistry
  • Female
  • Humans
  • Male
  • Middle Aged
  • Risk Factors
  • Sex Factors
  • United States


  • Bacterial Proteins
  • Bacterial Toxins
  • Enterotoxins
  • tcdA protein, Clostridium difficile
  • toxB protein, Clostridium difficile