Clostridioides difficile (C. diff) is a bacterium (germ) that can cause severe diarrhea and inflammation of the large intestine (colitis). Causing an estimated half-million infections in the U.S. each year, these contagious bacteria can even be life-threatening. In this article, we explore the relationship between IBD and C.Diff.
[You can read more about C. diff in our first article in this series, Understanding Your Risk for C. Diff Infection]
Most C. diff cases occur after taking antibiotics and in those spending time in 0laces like hospitals and nursing homes. However, patients with inflammatory bowel disease (IBD) are at greater risk of contracting C. diff. Most who have both IBD and C. diff were exposed to the bacteria in the community and tend to be younger. Those who have IBD can get C. diff even if they’re not taking antibiotics. IBD increases the risk of developing more severe C. diff infections and of recurrences.
IBD and C. diff, risk, Infection, and Treatment Options
Chronic intestinal inflammation from IBD destroys beneficial bacteria in the intestinal environment (microbiome) that normally would be able to resist C. diff infection. In addition, immunosuppressive drugs used to treat IBD, including corticosteroids, suppress the immune system’s ability to fight infection.
The main symptoms of C. diff—watery diarrhea, fever, and abdominal pain—are similar to IBD symptoms, leaving no easy way to distinguish between IBD and C Diff. That is why all patients with IBD who are experiencing a symptom flare should be tested for C. diff infection without delay.
It is very important to have the earliest possible diagnosis of C. diff infection in people with IBD because treatment must be individualized so that their IBD is under control while they take antibiotics to fight the C. diff infection. This can be challenging because the immunosuppressive drugs that patients take to control IBD may worsen the underlying C. diff infection, and antibiotics to fight C. diff may have injurious effects on the microbiome.
Balancing Antibiotics and Immunosuppressant Treatment
- The recommended treatment for a first-time C. diff infection in IBD patients are the antibiotics vancomycin or fidaxomicin.
- Patients with IBD and C. diff should be treated with antibiotics for a longer period than patients who do not have IBD because of the higher rate of treatment failure and recurrence in IBD patients when shorter courses of antibiotics are used.
- Immunosuppressive therapy for IBD during a C. diff infection, specifically corticosteroids, must be balanced individually and used with caution.
- Patients with recurrent C. diff infections should be considered for microbiota restoration therapies such as fecal microbiota transplantation (FMT)—a safe and well-tolerated treatment in IBD patients that has been shown to be highly effective for prevention of recurrent C. diff.
Are There Dietary Changes That Can Help Prevent C. diff ?
Certain dietary changes can help improve gut health and possibly prevent C. diff infection. Increasing probiotics in your diet can help repopulate the gut with beneficial bacteria and reduce the risk for regrowth of C. diff. Probiotics are found in fermented food such as yogurt, kefir, sauerkraut, tempeh, kimchi, and miso. Be sure that the labels on the products you buy state that they contain live cultures. Over-the-counter probiotic supplements can also be purchased in pharmacies and some supermarkets.
What About Dietary Recommendations During a C. diff Infection?
During and after a C. diff infection, these dietary changes can help reduce stomach pain, gas, and cramps and promote healing:
- Include soluble fiber (oats/oat bran, oatmeal, beans, peas, carrots, barley, citrus fruits, strawberries, and apple pulp) in your diet.
- Avoid insoluble fiber (wheat bran/whole wheat bread, wheat cereals, rye, brown rice, most other whole grains, cabbage, beets, Brussels sprouts, turnips, cauliflower, and apple skin).
- Avoid nuts, seeds, and gassy foods such as cruciferous veggies like cabbage, cauliflower, Brussels sprouts, and broccoli.
- Avoid spicy, fried or greasy foods, caffeinated beverages, high-fat foods, and beans.
- Drink enough liquid to avoid dehydration from diarrhea; water and broth soups can help.
- Stick with easy-to-digest foods: starchy foods such as bananas, potatoes, noodles, and white rice; easy-to-digest protein-rich foods such as eggs, chicken, and turkey; and cooked non-cruciferous vegetables, which can be made into smoothies or soup (beets, green beans zucchinis, cucumbers).
- Avoid milk and dairy products during a C. diff infection (with the exception of yogurt containing active cultures).
If you want to learn more about Inflammatory Bowel Disease here are some outstanding resources:
Color of Crohn’s and Chronic Illness – a nonprofit improving the quality of life for BIPOC who are affected by IBD, Digestive Disorders and associated Chronic Illnesses; through Community, Research, Education, and Advocacy
IBD Moms – tools created by moms with inflammatory bowel disease (IBD) for moms affected by inflammatory bowel disease as patients or caregivers
“Attitudes about Socialization, Clinical Trials, Medication Use & Treatments in People of Color with Inflammatory Bowel Disease” – lengthy article produced by Patients Rising based on our “Engaging People of Color with Inflammatory Bowel Disease” project.
Jacqueline Syrop is a health editor and writer specializing in information for patients and their caretakers. You can find her on Linkedin.