What Intestinal Infections Can Reveal About Celiac Disease and IBD Characteristics

Intestinal infections in patients with celiac disease (CeD) and inflammatory bowel disease (IBD) are associated with disease-specific characteristics, according to a study published in the Journal of Clinical Gastroenterology.

Compared with the general population, patients with CeD and IBD are at increased risk for systemic infections. Because the prevalence of gastrointestinal (GI) infections due to pathogens other than Clostridium difficile in the patient population had not been fully explored, researchers saw an opportunity to investigate the pattern of enteric infections in CeD and IBD for further insight into microbiome-mediated pathogeneses.

Researchers sought to identify the clinical factors of CeD and IBD associated with a positive stool GI polymerase chain reaction (GIPCR) test by performing a retrospective study of adult patients with CeD and IBD at a large quaternary care institution. A total of 266 patients with CeD (n=92; 35%) or IBD (n=174; 65%) who underwent stool GIPCR evaluation as outpatients (office visit or at endoscopy) between March 2015 and March 2019 were included in the study. Patients with a negative GIPCR test were randomly assigned 1:1 as control participants.

Study participants had a mean age of 33±17 years, 88% were White, and 80% were women.

On a multivariable analysis of factors associated with a positive GIPCR test, the researchers found that patients with CeD were more likely to have diarrheal presentation of illness (odds ratio [OR], 2.61; 95% CI, 1.05-6.72), experience extraintestinal manifestations (OR, 2.49; 95% CI, 1.01-6.31), and follow a gluten-free diet for at least 5 years (OR, 4.00; 95% CI, 1.36-11.67), relative to those with a negative GIPCR test. In patients with IBD and a positive GIPCR, the data indicated that patients were more likely to be on corticosteroids (OR, 2.23; 95% CI, 1.02-4.84), experience extraintestinal manifestations (OR, 2.60; 95% CI, 1.22-5.53), and use proton-pump inhibitors (OR, 4.07; 95% CI, 1.69-9.77), relative to patients with a negative GIPCR test.

“These relationships warrant further investigation, as the associations between enteric infection and unique disease characteristics may allow further insight into gut dysbiosis and ultimately disease pathogenesis and course, with potential therapeutic implications,” the researchers noted.

Reference

Varma S, Green PH, Krishnareddy S. Clinical factors associated with positive stool PCR for gastrointestinal pathogens in celiac and inflammatory bowel disease. J Clin Gastroenterol. 2022;56(3):e196–e202. doi:10.1097/MCG.0000000000001657

This article originally appeared on Gastroenterology Advisor