Post-Infectious Irritable Bowel Syndrome with Functional Diarrhea Following C. difficile Infections: Case Studies of Responses Using Serum-Derived Bovine Immunoglobulin

Carl V. Crawford, Raymond Michael Panas


Introduction: Post-infectious irritable bowel syndrome with diarrhea (PI-IBS-D) can result from any number of enteric infections. Two case histories investigate patients with IBS-D following recurrent Clostridium difficile infections and the benefits found using a prescription medical food, serum-derived bovine immunoglobulin/protein isolate (SBI), which is indicated for the management of chronic loose and frequent stools in such conditions as IBS-D and HIV-associated enteropathy. Case Presentations: Both patients were treated for relapsing C. difficile infections and eventually cleared. Despite negative C. difficile cultures, the 39-year old Caucasian female patient had diarrhea that never resolved and cholestyramine resulted in significant bloating. The severity of her condition led her to file for disability. Within two weeks of starting SBI 5 g QID, her diarrhea had resolved but returned upon discontinuation. SBI was restarted resulting again with resolution of her diarrhea. She continues on SBI 5g BID and has returned back to work. The second patient, 57-year old Caucasian female experienced ongoing diarrhea with alternating bouts of constipation. Upon use of SBI 5g BID, she noticed improvement within a few days. Therapy was reduced to SBI 5g QD to avoid possible constipation and reports regulation of her bowel habits. Discussion: These cases highlight the difficulties that result from C. difficile associated PI-IBS, the management that SBI can provide when considered an option for therapy, and the impact disease manifestations can have on quality of life. These cases further suggest the need for additional study of this nutritional agent in post-C. difficile infectious IBS patients.


Irritable Bowel Syndrome, Diarrhea, Post-Infectious, Serum-derived, Immunoglobulin, IgG, Bovine, Medical Food


Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology 2006;130:1480-1491. [PMID: 16678561 doi: 10.1053/j.gastro.2005.11.061]

American Colllege of Gastroenterology Task Force on Irritable Bowel Syndrome, Brandt LJ, Chey WD, Foxx-Orenstein AE, Schiller LR, Schoenfeld PS, Spiegel BM, Talley NJ, Quigley EM. An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol 2009;104(Suppl 1):S1–S35 [PMID: 19521341 doi: 10.1038/ajg.2008.122]

Spiller R, Lam C. The shifting interface between IBS and IBD. Curr Opin Pharmacol 2011;11(6):586-592. [PMID: 22000604 doi: 10.1016/j.coph.2011.09.009]

Stanisic V, Quigley EM. The overlap between IBS and IBD – what is it and what does it mean? Expert Rev Gastroenterol Hepatol 2014;8(2):139-145. [PMID: 24417262 doi: 10.1586/17474124.2014.876361]

Saito YA, Schoenfeld P, Locke GR III. The epidemiology of irritable bowel syndrome in North America: a systematic review. Am J Gastroenterol 2002;97:1910–1915. [PMID: 12190153 doi: 10.1111/j.1572-0241.2002.05913.x]

Spiller R. Garsed K. Postinfectious irritable bowel syndrome. Gastroenterology 2009;136:1979-1988. [PMID: 19457422 doi: 10.1053/j.gastro.2009.02.074]

Dunlop SP, Jenkins D, Spiller RC. Distinctive clinical, psychological, and histological features of postinfective irritable bowel syndrome. Am J Gastroenterol 2003;98:1578-1583. [PMID: 12873581 doi: 10.1111/j.1572-0241.2003.07542.x]

Schwille-Kiuntke J, Frick J-S, Zanger P, Enck P. [Post-Infectious Irritable Bowel Syndrome – A Review of the Literature]. Zeitschrift fur Gastroenterologie 2011;49(8):997-1003. [doi: 10.1055/s-0031-1281581]

Ohman L, Simrén M. Pathogenesis of IBS: role of inflammation, immunity and neuroimmune interactions. Nat Rev Gastroenterol Hepatol 2010;7:163–173. [PMID: 20101257 doi: 10.1038/nrgastro.2010.4]

Zhou Q, Verne GN. New insights into visceral hypersensitivity--clinical implications in IBS. Nat Rev Gastroenterol Hepatol 2011;8:349–355. [PMID: 21643039 doi: 10.1038/nrgastro.2011.83]

Locke GR, Clark S, Cerulli A, Marehbian J, Kahler KH, Shetzline MA. Work productivity is more impaired in functional gastrointestinal disorders compared to GERD: six-month data from PROGRESS [abstract 1052]. Am J Gastroenterol 2007;102:S504. [doi: 10.1111/j.1572-0241.2007.01491_10.x]

Clouse RE. Managing functional bowel disorders from the top down: lessons from a well-designed treatment trial. Gastroenterology 2003;125:249-253. [PMID: 12851889 doi: 10.1016/S0016-5085(03)00808-4]

Krause R, Ameen V, Gordon SH, West M, Heath AT, et al. A randomized, double-blind, placebo-controlled study to assess efficacy and safety of 0.5 mg and 1 mg alosetron in women with severe diarrhea predominant IBS. Am J Gastroenterol 2007;102:1709-1719. [PMID: 17509028 doi: 10.1111/j.1572-0241.2007.01282.x]

Chey WD, Chey WY, Heath AT, Dukes GE, Carter EG, Northcutt A, Ameen VZ. Long-term safety and efficacy of alosetron in women with severe diarrhea-predominant irritable bowel syndrome. Am J Gastroenterol 2004;99:2195-2203. [PMID: 15555002 doi: 10.1111/j.1572-0241.2004.30509.x]

Lembo A, Zakko SF, Ferreira NC. T1390 rifaximin for the treatment of diarrhea associated irritable bowel syndrome: short-term treatment lending to long- term sustained response. Gastroenterology 2008;134:A545. [doi: 10.1016/S0016-5085(08)62544-5]

Pimentel M, Park S, Mirocha J, Kane SV, Kong Y. The effect of a nonabsorbed oral antibiotic (rifaximin) on the symptoms of the irritable bowel syndrome: a randomized trial. Ann Intern Med 2006;145:557-563. [PMID: 17043337]

Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology 2014;146:67-75. [PMID: 24076059 doi: 10.1053/j.gastro.2013.09.046]

Entera Health, Inc. (2014/04). EnteraGam Prescribing Information. []

Wilson D, Evans MD, Weaver E, Shaw AL, Klein GL. Evaluation of serum-derived bovine immunoglobulin protein isolate in subjects with diarrhea-predominant irritable bowel syndrome. Clin Med Insights Gastroenterol 2013;6:49-60. [PMID: 24833942 doi: 10.4137/CGast.S13200]

Asmuth DM, Ma ZM, Albanese A, Sandler NG, Devarai S, Knight TH, Flynn NM, Yotter T, Garcia JC, Tsuchida E, Wu TT, Douek DC, Miller CJ. Oral serum-derived bovine immunoglobulin improves duodenal immune reconstitution and absorption function in patients with hiv enteropathy. AIDS 2013;27:2207-2217. [PMID: 23660579 doi: 10.1097/QAD.0b013e328362e54c]

Petschow B, Burnett B, Shaw A, Weaver E, Klein G. Serum-derived bovine immunoglobulin/protein isolate: postulated mechanism of action for management of enteropathy. Clin Exp Gastroenterol 2014;7:1-10. [PMID: 24904221 doi: 10.2147/CEG.S62823]

Warny M, Fatimi A, Bostwick EF, Laine DC, Lebel F, LaMont JT, Pothoulaki C, Kelly CP. Bovine immunoglobulin concentrate-clostridium difficile retains C difficile toxin neutralising activity after passage through the human stomach and small intestine. Gut 1999;44(2):212–217. [PMID: 9895380]

Weaver EM, Klein GL, DeVries BK, Maas KJ, & Shaw A. Endotoxin neutralization activity (ENA) of bovine plasma and bovine Immunoglobulin (IgG)-rich fractions as compared to human plasma. FASEB, Boston, MA, 2013. [doi: 10.1096/fj.1530-6860]

Henderson AL, Horgan A, Detzel CJ, Maas KJ, & Weaver EM. Serum-derived bovine immunoglobulin/protein isolate binds and neutralizes clostridium difficile toxins A and B. Digestive Disease Week, Chicago, IL, 2014. [doi: 10.1016/S0016-5085(14)61030-1]

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