No abstract

The past decade has seen an alarming increase in the burden of disease associated with Clostridium difficile. [1][2][3][4] Studies from North America have demonstrated a doubling of incidence during this time period.3,4 The estimated economic costs associated with C difficile infection (CDI) range from $436 million to $3 billion in the United States annually. 5,6 Initially considered to play a key role in the development of antibiotic-associated pseudomembranous colitis, 7 C difficile is now known to cause a wide range of disease presentations ranging from asymptomatic carriage to fulminant colitis, toxic megacolon, sepsis, multiorgan failure, and death. Recent antibiotic exposure or hospitalization were previously considered key in the acquisition of CDI but recent data suggest an increasing number of CDI not associated with antibiotic use and infections being acquired in the community.Inflammatory bowel diseases (IBD; Crohn disease [CD], ulcerative colitis [UC]) are chronic, lifelong, immunologically mediated inflammatory disorders of the gut that present typically with symptoms of abdominal pain, diarrhea, or rectal bleeding. 8 Several studies have now demonstrated an increasing incidence of CDI in patients with IBD with a more severe course of disease compared with the non-IBD population. [9][10][11][12][13][14] The similarity in symptoms between the two conditions (CDI and an IBD flare) but markedly divergent treatment plans (specific-antibiotic therapy and potential reduction of immunosuppression for CDI in the setting of IBD compared with escalation of immunosuppressive therapy for an IBD flare) makes it essential for treating physicians to be aware of the impact of CDI on patients with IBD, have a high index

Vitamin D deficiency is common in IBD and is independently associated with lower HRQOL and greater disease activity in CD. There is a need for prospective studies to assess this correlation and examine the impact of vitamin D supplementation on disease course.

Permanent work disability administered through social security was encountered in 5.3% of the Crohn's patients followed in our cohort. Patients who consistently report low quality of life, or have frequent flares requiring surgical intervention or hospitalization for medical management, may be at risk for CD-related work disability.

Most patients with negative QFT-G tolerated anti-TNF therapy with no evidence of TB reactivation. Concomitant use of immunosuppressive therapy or anti-TNF did not seem to affect QFT-G results. One patient had an indeterminate QFT-G while on infliximab and later developed miliary TB. Concordance with TST is moderate.