Yingxi Chen1, Luis Furuya-Kanamori, Suhail A Doi, Ashwin N Ananthakrishnan, Martyn Kirk. 1. *Research School of Population Health, Australian National University, Canberra, Australia; †College of Medicine, Qatar University, Doha, Qatar; ‡School of Agricultural, Computational, and Environmental Sciences, University of Southern Queensland, Toowoomba, Australia; and §Division of Gastroenterology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts.
Abstract
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; I = 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.
BACKGROUND:Clostridium difficileinfection (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; I = 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.
Authors: Alyce Anderson; Benjamin Click; Claudia Ramos-Rivers; Debbie Cheng; Dmitriy Babichenko; Ioannis E Koutroubakis; Jana G Hashash; Marc Schwartz; Jason Swoger; Arthur M Barrie; Michael A Dunn; Miguel Regueiro; David G Binion Journal: Inflamm Bowel Dis Date: 2017-12 Impact factor: 5.325
Authors: Ruixue Liu; Richard Moriggl; Dongsheng Zhang; Haifeng Li; Rebekah Karns; Hai-Bin Ruan; Haitao Niu; Christopher Mayhew; Carey Watson; Hansraj Bangar; Sang-Wook Cha; David Haslam; Tongli Zhang; Shila Gilbert; Na Li; Michael Helmrath; James Wells; Lee Denson; Xiaonan Han Journal: Life Sci Alliance Date: 2019-04-04
Authors: Massimo Sartelli; Stefano Di Bella; Lynne V McFarland; Sahil Khanna; Luis Furuya-Kanamori; Nadir Abuzeid; Fikri M Abu-Zidan; Luca Ansaloni; Goran Augustin; Miklosh Bala; Offir Ben-Ishay; Walter L Biffl; Stephen M Brecher; Adrián Camacho-Ortiz; Miguel A Caínzos; Shirley Chan; Jill R Cherry-Bukowiec; Jesse Clanton; Federico Coccolini; Maria E Cocuz; Raul Coimbra; Francesco Cortese; Yunfeng Cui; Jacek Czepiel; Zaza Demetrashvili; Isidoro Di Carlo; Salomone Di Saverio; Irina M Dumitru; Christian Eckmann; Edward H Eiland; Joseph D Forrester; Gustavo P Fraga; Jean L Frossard; Donald E Fry; Rita Galeiras; Wagih Ghnnam; Carlos A Gomes; Ewen A Griffiths; Xavier Guirao; Mohamed H Ahmed; Torsten Herzog; Jae Il Kim; Tariq Iqbal; Arda Isik; Kamal M F Itani; Francesco M Labricciosa; Yeong Y Lee; Paul Juang; Aleksandar Karamarkovic; Peter K Kim; Yoram Kluger; Ari Leppaniemi; Varut Lohsiriwat; Gustavo M Machain; Sanjay Marwah; John E Mazuski; Gokhan Metan; Ernest E Moore; Frederick A Moore; Carlos A Ordoñez; Leonardo Pagani; Nicola Petrosillo; Francisco Portela; Kemal Rasa; Miran Rems; Boris E Sakakushev; Helmut Segovia-Lohse; Gabriele Sganga; Vishal G Shelat; Patrizia Spigaglia; Pierre Tattevin; Cristian Tranà; Libor Urbánek; Jan Ulrych; Pierluigi Viale; Gian L Baiocchi; Fausto Catena Journal: World J Emerg Surg Date: 2019-02-28 Impact factor: 5.469