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World J Gastroenterol. Sep 21, 2026; 32(35): 118677
Published online Sep 21, 2026. doi: 10.3748/wjg.118677
Association between Clostridioides difficile colonization and inflammatory bowel disease activity in outpatients with remission
Oscar Morado-Aramburo, Eric Ochoa-Hein, Ma T Pérez-Gutiérrez, María N Sánchez-Cruz, Miriam Bobadilla-del-Valle, Jesús K Yamamoto-Furusho, Alfredo Ponce-de-Leon, Jose Sifuentes-Osornio
Oscar Morado-Aramburo, Ma T Pérez-Gutiérrez, Alfredo Ponce-de-Leon, Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Ciudad de México, Mexico
Eric Ochoa-Hein, Department of Hospital Epidemiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Ciudad de México, Mexico
María N Sánchez-Cruz, Miriam Bobadilla-del-Valle, Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Ciudad de México, Mexico
Jesús K Yamamoto-Furusho, Department of Gastroenterology and Intestinal Bowel Disease, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Ciudad de México, Mexico
Jose Sifuentes-Osornio, General Directorate, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Ciudad de México, Mexico
Author contributions: Morado-Aramburo O, Pérez-Gutiérrez MT, Sánchez-Cruz MN and Bobadilla-del-Valle M contributed to conceptualization and design; Morado-Aramburo O, Ochoa-Hein E, Pérez-Gutiérrez MT, Sánchez-Cruz MN, Bobadilla-del-Valle M, Yamamoto-Furusho JK, Ponce-de-León A and Sifuentes-Osornio J contributed to material preparation, data acquisition, and analysis; Morado-Aramburo O, Ochoa-Hein E, Pérez-Gutiérrez MT, Sánchez-Cruz MN, Bobadilla-del-Valle M, Yamamoto-Furusho JK, Ponce-de-Leon A, Sifuentes-Osornio J contributed to writing-draft manuscript and writing-revision and approved to submit the final version.
AI contribution statement: AI was not used for designing, conducting or reporting this work.
Institutional review board statement: This study was approved by the Institutional Review Board of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (Reference No. 2189).
Clinical trial registration statement: Due to the fact that the study is not a clinical trial, the clinical trial registration statement does not apply.
Informed consent statement: All participants provided written informed consent before inclusion in the study.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CONSORT 2010 statement: Due to the fact that the study is not a clinical trial, the CONSORT 2010 statement does not apply.
Data sharing statement: Data sharing is available upon request.
Corresponding author: Eric Ochoa-Hein, MD, Physician, Department of Hospital Epide
miology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Col. Belisario Domínguez Sección XVI, Alcaldía Tlalpan, Mexico City 14080, Ciudad de México, Mexico.
dr_eric_ochoa@yahoo.com.mx
Received: January 27, 2026
Revised: April 18, 2026
Accepted: June 4, 2026
Published online: September 21, 2026
Processing time: 204 Days and 16.4 Hours
BACKGROUND
Clostridioides difficile (C. difficile) colonization (CDC) has been suspected as a contributing factor to inflammatory bowel disease (IBD) activity. However, a major limitation of previous studies is that the majority of included patients had active IBD at baseline.
AIM
To evaluate the possible association between CDC and IBD activity in outpatients without disease activity at study inclusion.
METHODS
This was a prospective cohort study conducted at a single tertiary care center. Adult patients with IBD in remission were included. Three stool samples were obtained per participant during a minimum follow-up period of 6 months. CDC was defined as the presence of a positive culture for C. difficile, a positive glutamate dehydrogenase test, and a negative toxin test in patients with remitted IBD. CDC incidence was calculated, and its association with IBD activity was assessed using Cox regression analysis. A P value ≤ 0.05 was considered statistically significant.
RESULTS
Of 250 eligible candidates, 101 were included; 59.4% were women, and the median age was 49.0 years. The baseline prevalence of CDC was 13.9%. Slightly more than two-thirds of participants remained in remission during follow-up. After a median follow-up of 420 days, the incidence of CDC was 8.2 per 100 person-years. No association was found between CDC and IBD activity. In multivariate analysis, only prior healthcare utilization (hazard ratio = 3.48, 95% confidence interval: 1.26-9.57, P = 0.016) remained statistically significantly associated with IBD activity.
CONCLUSION
No association was observed between CDC and IBD activity in this prospective study of patients with IBD in clinical and biochemical remission.
Core Tip: This prospective study evaluated the association between Clostridioides difficile (C. difficile) colonization (CDC) and inflammatory bowel disease (IBD) flares in patients in remission at baseline. Using stringent diagnostic criteria, no association was observed between CDC and subsequent IBD activity during a median follow-up longer than 1 year. Although baseline prevalence and incidence of CDC were relatively high, C. difficile infection events were infrequent, and approximately 70% of participants remained free of disease flares. The observed association between younger age at IBD diagnosis and CDC warrants further investigation.
