Enteropathogenic Escherichia coli May Indicate Inflammatory Bowel Disease

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.

Reference

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