Descriptive analysis of Infective Colitis in a large hospital cohort: Features in IBD and non-IBD patients

Abstract

Background: Clinical features associated with infective colitis and flare up of Inflammatory Bowel Disease (IBD) are very similar and presents a challenge to gastroenterologists to distinguish the two. This is especially difficult in patients with established IBD disease in whom the incidence of bacterial infections is comparable to the general population.

Methods: This was a retrospective analytical cohort study conducted at Leeds Teaching Hospitals (LTHT), UK. Subjects included were those with diarrhoeal symptoms, referred by the emergency department or primary care physicians to the Gastroenterology unit of LTHT, over an eight-year period between 2004-2012, with a positive stool culture for Campylobacter, Salmonella, Shigella or E.Coli O157.

Results: We analysed 102 consecutive cases. Median duration of symptoms was 4 days (IQR 2 – 7). The most common reported symptom was abdominal pain 91 patients (91%), followed by rectal bleeding 53 patients (52%) and vomiting 44 patients (43%). Blood tests revealed that 98% patients had a substantially elevated C-reactive protein (CRP) concentration [median 95 mg/L (IQR 44-143)]. Thirteen patients had pre-existing IBD, who when compared to non-IBD patients, showed no difference in clinical presentation. In the IBD group, however, median platelet count was significantly higher [282 (IQR 225-415) vs 237 (IQR 194-281) p=0.03) and haemoglobin concentration lower [12.1 (IQR 11-14) v 14.3 (IQR 13-15) p=0.01).

Conclusions: In patients where infective diarrhoea is suspected a short duration of symptoms, abdominal pain and elevated CRP concentration are pointers that can support the diagnosis, whereas low Haemoglobin and high Platelet count favours a background of IBD.