TY - JOUR
T1 - Clostridium difficile Infection and Risk of Colectomy in Patients with Inflammatory Bowel Disease
T2 - A Bias-adjusted Meta-analysis
AU - Chen, Yingxi
AU - Furuya-Kanamori, Luis
AU - Doi, Suhail A.
AU - Ananthakrishnan, Ashwin N.
AU - Kirk, Martyn
N1 - Publisher Copyright:
© Copyright 2017 Crohn's & Colitis Foundation of America, Inc.
PY - 2017/2/1
Y1 - 2017/2/1
N2 - Background: Clostridium difficile infection (CDI) is a common complication of inflammatory bowel diseases (IBDs) and is associated with worse outcome. Variable rates of colectomy have been reported among IBD complicated by CDI. We conducted a systematic review and meta-analysis of studies to assess the association between CDI and colectomy among patients with IBD. Methods: The literature was systematically searched using PubMed from inception through April 2016. Studies were limited to cohort, case-control, and cross-sectional studies reporting colectomy risk stratified by CDI in patients with IBD. We estimated summary ORs and 95% CIs using the quality-effects model. Study quality was assessed using an adaptation of the Newcastle-Ottawa scale. Results: Six studies were included in the meta-analysis, comprising 8 data sets. Results from meta-analysis showed that CDI was a significant risk factor for colectomy among patients with IBD, mainly patients with ulcerative colitis, almost doubling the odds (OR 1.90; 95% CI, 1.23-2.93). There was significant heterogeneity across studies (Q = 22.02, P < 0.001; I2 = 68%). Funnel plots were grossly asymmetrical. Results of sensitivity analysis restricting studies to those reporting ulcerative colitis only and studies using laboratory tests to confirm CDI were consistent with the result from the main analysis. Conclusions: CDI is a significant risk factor for colectomy in patients with IBD. Further research is needed to investigate the attributable risks of surgery due to CDI among patients with Crohn's disease.
AB - Background: Clostridium difficile infection (CDI) is a common complication of inflammatory bowel diseases (IBDs) and is associated with worse outcome. Variable rates of colectomy have been reported among IBD complicated by CDI. We conducted a systematic review and meta-analysis of studies to assess the association between CDI and colectomy among patients with IBD. Methods: The literature was systematically searched using PubMed from inception through April 2016. Studies were limited to cohort, case-control, and cross-sectional studies reporting colectomy risk stratified by CDI in patients with IBD. We estimated summary ORs and 95% CIs using the quality-effects model. Study quality was assessed using an adaptation of the Newcastle-Ottawa scale. Results: Six studies were included in the meta-analysis, comprising 8 data sets. Results from meta-analysis showed that CDI was a significant risk factor for colectomy among patients with IBD, mainly patients with ulcerative colitis, almost doubling the odds (OR 1.90; 95% CI, 1.23-2.93). There was significant heterogeneity across studies (Q = 22.02, P < 0.001; I2 = 68%). Funnel plots were grossly asymmetrical. Results of sensitivity analysis restricting studies to those reporting ulcerative colitis only and studies using laboratory tests to confirm CDI were consistent with the result from the main analysis. Conclusions: CDI is a significant risk factor for colectomy in patients with IBD. Further research is needed to investigate the attributable risks of surgery due to CDI among patients with Crohn's disease.
KW - Clostridium difficile infection
KW - colectomy
KW - inflammatory bowel disease
KW - meta-analysis
UR - http://www.scopus.com/inward/record.url?scp=85010903997&partnerID=8YFLogxK
U2 - 10.1097/MIB.0000000000000998
DO - 10.1097/MIB.0000000000000998
M3 - Review article
SN - 1078-0998
VL - 23
SP - 200
EP - 207
JO - Inflammatory Bowel Diseases
JF - Inflammatory Bowel Diseases
IS - 2
ER -