Persistent bowel symptoms post-Clostridium difficile Infection
Research type
Research Study
Full title
Persistent bowel symptoms post-Clostridium difficile infection (CDI): Better definition of symptoms, insights into possible mechanisms and appropriate management
IRAS ID
242347
Contact name
Lesley Anne Houghton
Contact email
Duration of Study in the UK
4 years, 11 months, 31 days
Research summary
Clostridium difficile infection (CDI) is associated with significant illness and sometimes death. About one quarter of patients experience recurrent CDI. A less well-understood issue is how frequently CDI can lead to irritable bowel syndrome (IBS), which includes diarrhoea and notably could be confused as recurrent CDI. Unfortunately, inappropriate treatment of symptoms suspected to be recurrent CDI, which are actually due to IBS, with antibiotics, can increase the risk of a true recurrence of CDI. Only a few studies have tried to measure if the symptoms that follow initial CDI could be IBS, but these have not properly identified CDI, because they relied on poor tests for this infection. Our research will accurately diagnose CDI, and so will measure the true rate of IBS, along with other similar gut disorders.
Patients (>18 years) who suffer from a diarrhoeal illness and had their stool checked for CDI will be identified using the current European guideline two-step approach for accurate CDI diagnosis (i.e. both glutamate dehydrogenase (GDH) antigen and toxin positive). Patients will be divided into those with confirmed CDI (both GDH and toxin positive; Group 1), those positive for GDH only (C. Difficile colonised but not producing toxin; Group 2), and those negative for GDH (no C. Difficile infection; Group 3). Questionnaires will be distributed to all identified patients to identify those with IBS and similar disorders.
We will also determine whether the presence of certain gastrointestinal (e.g. heartburn) and non-gastrointestinal (e.g. muscular pain) disorders prior to initial CDI influences IBS development following CDI. These risk factors, along with accurate CDI diagnostic testing, might help doctors to identify patients most likely to have IBS and avoid inappropriate use of antibiotics. We believe this study is needed to improve the overall management of CDI and ensure that its consequences are treated appropriately.
REC name
North West - Greater Manchester West Research Ethics Committee
REC reference
18/NW/0246
Date of REC Opinion
26 Apr 2018
REC opinion
Further Information Favourable Opinion