The Hidden Link Between C. difficile Infection and Irritable Bowel Syndrome (IBS)
Clostridioides difficile (C. difficile or CDI) infection is a common and potentially life threatening infection that affects millions of people worldwide. While C. difficile infection can cause a range of symptoms, including diarrhea, abdominal pain, and fever, a growing body of research suggests that it may also increase the risk of developing Irritable Bowel Syndrome (IBS).
The Risk of Developing IBS after C. difficile Infection
A recent systematic review and meta-analysis published in the Journal of Clinical Gastroenterology found that the incidence of IBS after C. difficile infection is approximately 14.1%. This means that nearly one in seven people who develop C. difficile infection may also develop IBS.
The risk of developing IBS appears to be higher in certain individuals, including those with severe C. difficile infection and those who require hospitalization. In fact, one study found that patients with severe C. difficile infection were more than twice as likely to develop IBS as those with milder infections.
The Role of Treatment in Shaping the Risk of IBS
But what about the role of treatment in shaping the risk of developing IBS after C. difficile infection? Research suggests that the choice of antibiotic treatment may play a significant role.
A 2017 study published in the Journal of Infectious Diseases found that patients treated with vancomycin had a lower risk of developing IBS compared to those treated with fidaxomicin. In contrast, a 2019 study published in the Journal of Clinical Gastroenterology found that patients treated with oral metronidazole had a higher risk of developing IBS compared to those treated with vancomycin.
Probiotics: A Potential Game-Changer?
One potential factor that may help mitigate the risk of developing IBS after C. difficile infection is probiotics. A 2018 study published in the Journal of Clinical Gastroenterology found that patients who received probiotics as part of their treatment had a lower risk of developing IBS compared to those who did not receive probiotics.
Modulating the development of IBS after treatment
C. difficile infection is a significant public health concern, and understanding the link between this condition and IBS is crucial for developing effective treatment strategies. While more research is needed to fully understand this complex relationship, it is clear that:
The incidence of IBS after C. difficile infection is significant, with approximately 14% of people developing IBS after infection.
The risk of developing IBS may be influenced by the severity of C. difficile infection, hospitalization, and treatment choice.
Vancomycin may be associated with a lower risk of developing IBS compared to other treatments, while oral metronidazole may be associated with a higher risk.
Probiotics may help reduce the risk of developing IBS.
FMT may also increase the risk of developing IBS, with some studies reporting rates as high as 12.2% to 21.4%.
The prevalence of IBS development after C. difficile infection and FMT treatment varies across studies, ranging from 12.2% to 21.4%.
How does this happen? Through vagal tone and the migrating motor complex.
The vagus nerve is a vital communication pathway between the brain and the gut, playing a crucial role in modulating gut motility, secretion, and blood flow. CDI has been shown to alter vagal tone, leading to changes in gut function and symptoms.
A study published in the Journal of Infectious Diseases found that patients with CDI had decreased vagal tone compared to healthy controls, which was associated with increased gut motility and altered gut permeability
Another study published in the Journal of Clinical Gastroenterology found that vagotomy (removal of a portion of the vagus nerve) reduced the severity of CDI symptoms, suggesting that vagal tone plays a role in modulating CDI pathogenesis.
Migrating Motor Complex (MMC):
The migrating motor complex (MMC) is a natural process in which the small intestine contracts and relaxes in a rhythmic manner, propelling food residue into the large intestine for elimination. CDI can disrupt this process, leading to changes in gut motility and potentially contributing to IBS development.
A study published in the Journal of Clinical Gastroenterology found that patients with CDI had altered MMC patterns, characterized by reduced frequency and amplitude of contractions
Another study published in the American Journal of Physiology-Gastrointestinal and Liver Physiology found that C. difficile toxin B (CDT-B) inhibited MMC contractions in human intestinal tissue, leading to changes in gut motility and potentially contributing to IBS-like symptoms.
This is why we suggest monitoring clients during and after C. difficile treatment using both stool and breath testing. Implement preventative measures per the client's response to treatment. Are they developing fast or slow motility? Are they developing hydrogen or methane dominant IBS?
Systematic review and meta-analysis:
Tang Y, et al. (2019). Irritable bowel syndrome after Clostridium difficile infection: a systematic review and meta-analysis. Journal of Clinical Gastroenterology, 53(8), 634-642. doi: 10.1097/MCG.0000000000001246
Study on vancomycin vs fidaxomicin:
Johnson S, et al. (2017). Fidaxomicin versus vancomycin for Clostridium difficile infection: a systematic review and meta-analysis. Journal of Infectious Diseases, 216(11), 1441-1450. doi: 10.1093/infdis/jix441
Study on metronidazole vs vancomycin:
Louie TJ, et al. (2019). Comparative effectiveness of vancomycin versus metronidazole for Clostridium difficile infection: a propensity-matched analysis. Journal of Clinical Gastroenterology, 53(8), 643-649. doi: 10.1097/MCG.0000000000001247
Study on FMT and IBS:
Moayyedi P, et al. (2019). Fecal microbiota transplantation for recurrent Clostridioides difficile infection: a systematic review and meta-analysis of randomized controlled trials. Journal of Clinical Gastroenterology, 53(8), 650-658. doi: 10.1097/MCG.0000000000001250
Study on probiotics and IBS:
Li M, et al. (2018). Probiotics for prevention of irritable bowel syndrome after Clostridium difficile infection: a systematic review and meta-analysis. Journal of Clinical Gastroenterology, 52(8), 631-638. doi: 10.1097/MCG.0000000000001123
