Enteropathogenic Escherichia coli May Indicate Inflammatory Bowel Disease

e coli
e coli
Researchers analyzed patients hospitalized for diarrhea with positive stool pathogen testing and a new diagnosis of IBD to find out more about the pathogenesis of IBD.

The Escherichia coli species may be associated with the development of inflammatory bowel disease (IBD), according to findings from a retrospective analysis published in the Journal of Clinical Gastroenterology.

Investigators retrospectively reviewed medical records from patients (N=54) hospitalized for more than 24 hours because of diarrhea at New York-Presbyterian/Columbia University Irving Medical Center between 2015 and 2019. All patients underwent gastrointestinal polymerase chain reaction (GIPCR) testing of stool for 13 bacteria, 5 viruses, and 4 parasites, were found to be positive for at least 1 pathogen, and later received a diagnosis of IBD.

Approximately half (54%) of the patients were women, White (56%), and diagnosed with Crohn disease (56%) or ulcerative colitis (44%). They were diagnosed at a median age of 35 years (interquartile range [IQR], 18-65), 3 months (IQR, 2-9) after a positive GIPCR test.

Before receiving a diagnosis of IBD, patients exhibited evidence of ongoing inflammation, with a median erythrocyte sedimentation rate of 41 mm/h (IQR, 21-57) and C-reactive protein of 41 mg/dL (IQR, 12-85).

The GIPCR test identified 69 unique organisms. Most patients (n=42) were positive for 1 pathogen. The maximum number of pathogens found in a test was 4 (n=1). The identified pathogens were bacteria (83%), viruses (13%), and parasites (4%).

Time to IBD diagnosis depended on pathogen type; patients with parasites were diagnosed in 1 month (IQR, 0.75-1), patients with viruses in 3 months (IQR, 1-8), and patients with bacteria in 6 months (IQR, 2-10); P =.001.

The most commonly identified pathogen was E coli (71%), specifically enteropathogenic E coli (38%).

Enteropathogenic E coli was observed among more women relative to other organisms (69% vs 39%; P =.02). Patients with enteropathogenic E coli were more likely to take psychotropic or neuropathic medications (35% vs 0; P <.01) and to have lower hemoglobin (9.2 vs 11.7; P <.01) and albumin (3.4 vs 3.8; P =.02) levels.

This study was limited by its observational design. Future studies will be needed to assess the causal relationship between IBD and E coli in stool.

These observations indicated that patients presenting with diarrhea and E coli in a GIPCR assessment may be predisposed for IBD.


Varma S, Green PH, Krishnareddy S. The distribution of gastrointestinal pathogens on stool PCR prior to the development of IBD. J Clin Gastroenterol. Published online November 25, 2020 doi:10.1097/MCG.0000000000001470