Similar Outcomes Identified in Comparison of C.Diff of Small Bowel and Colon

Hospitalizations were more likely in patients with CDI of small bowel and Crohn's disease, with worse outcomes noted in patients admitted to ICU.

A new study investigated clinical characteristics and outcomes of patients with clostridium difficile infection (CDI) in the small bowel, compared to patients with CDI of the colon, citing a lack of previous data.

Investigators, led by Asif A. Hitawala, MD of the Cleveland Clinic Fairview Hospital, determined that among hospitalized patients, those with CDI of the small bowel had similar outcomes as those with CDI of the colon, while Crohn’s disease was seemingly more prevalent in the former, making hospitalizations more likely.

The study was presented virtually at Digestive Disease Week (DDW) 2021 Virtual Conference..


Investigators performed a retrospective study to assess the clinical characteristics and outcomes of the two patient groups, those with CDI of the colon and CDI of the small bowel.

Data was drawn from all patients admitted to the Cleveland Clinic hospitals from January 2008 – January 2020, with a diagnosis of CDI in the small bowel.

Patient criteria included ≥18 years, with a positive clostridium difficile assay with stool sample from ileostomy, and documentation of active CDI.

The team then recruited 2 age- and sex- matched hospitalized patients with CDI of the colon for every 1 patient with CDI of the small bowel.

Data on clinical characteristics and outcomes were collected by the team, while data was analyzed using R software.


The study identified 36 cases of CDI of the small bowel, with a median age of 62.5 years and equal numbers in males and females.

In comparison with patients hospitalized with CDI of the colon, patients with CDI of the small bowel had more severe disease, antidiarrheal medication use on admission, and Crohn’s disease.

The two had similar treatment with metronidazole and/or vancomycin (P >.2), with a small duration of treatment (P = .851). Each patient group had a similar length of stay, death rate, and CDI recurrence within 56 days.

Further, investigators found admission to intensive care unit (ICU) had a significant association with death (P = .038), even after adjustment for group (P = .039).

Investigators also found opioid use had significant associations with CDI recurrence.

After adjustment for group, the presence of antibiotic use within the past 30 days (P = .019), concurrent antibiotic use for another infection (P = .015), use of prokinetics prior to admission (P = .034), and ICU admission (P <.001) had significant associations with longer hospital length of stay.


Investigators concluded the study outcomes tended to be similar in both patient groups and current treatment strategies are effective for CDI of the small bowel.

“Amongst hospitalized patients, patients with CDI of the small bowel tend to have similar outcomes as compared to those with CDI of the colon,” investigators wrote.

However, they noted that patients with CDI of the small bowel and Crohn’s disease may be more likely to be hospitalized, while patients admitted to ICU tend to have worse outcomes.

The study, “Clinical Characteristics and Outcomes of Clostridium Difficile Enteritis Versus Colitis Amongst Hospitalized Patients: A Retrospective Case Control Study,” was published online by DDW.