B0642 - Celiac Disease Patients Have Higher Risk for Clostridium difficile Infections: A Population-Based Study

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

EK

Eduard Krishtopaytis, MD

Cleveland Clinic Foundation
Fairview Park, Ohio

Eduard Krishtopaytis, MD¹, Ashraf Almomani, MD², Prabhat Kumar, MD², Somtochukwu Onwuzo, MD², Antoine Boustany, MD, MPH², Asif Hitawala, MD³, Dana Alshaikh, MD⁴, Imad Asaad, MD⁵, Osama Abu-Shawer, MD, MS⁶
¹Cleveland Clinic Foundation, Fairview Park, OH; ²Cleveland Clinic Foundation, Cleveland, OH; ³National Institutes of Health, Bethesda, MD; ⁴Mutah University, Amman, Al Karak, Jordan; ⁵Cleveland Clinic Foundation, Westlake, OH; ⁶Cleveland Clinic, Cleveland, OH

Introduction: Clostridium difficile infection (CDI) is a common gastrointestinal pathology with the incidence in the United States to 20-30 per 100 000 population. Previous studies showed association of Celiac disease and CDI, however the prevalence of CDI in patients with celiac disease has not been described in literature.

Our aim is to estimate the prevalence of CDI among celiac patients, and to assess whether celiac disease is an independent risk factor for CDI.

Methods: A large multi-center database (Explorys Inc., Cleveland, OH, USA) of aggregated electronic health records of 26 different healthcare systems with a total of 360 hospitals and more than 70 million patients across the United States was utilized for this study. A cohort of patients with Celiac disease was identified. Later, a second sub-cohort of those who also had CDI was identified. We excluded all the patients age < 18, patients with inflammatory bowel diseases, immunosuppressed, HIV, Roux-en-Y bypass. Statistical Package for Social Sciences (SPSS version 25, IBM Corp) was used for statistical analysis, and for all analyses, a 2-sided p-value of < 0.05 was considered statistically significant. Multivariate analysis was performed to adjust for multiple factors including age, sex, race, smoking, use of proton pump inhibitors, diagnosis of celiac disease.

Results: Among the 80,884,400 individuals screened in the database there were total of 143,180 with Celiac disease (0.17%). The baseline characteristics of patients with Celiac disease are represented in Table 1. Celiac disease was independently associated with a higher risk of developing CDI (OR= 2.592). Other factors associated with risk of CDI included age 18-65 (OR= 2.764), Caucasian race (OR =1.880), smoking (OR= 1.540), use of proton pump inhibitors (OR= 8.468) as in Table 2.

Discussion: Celiac disease seems to be an independent risk factor for CDI. Further studies are required to investigate specifics of pathophysiology, diagnosis and treatment of CDI in patient with celiac disease.

Figure: Table 2. Multivariable analysis for risk factors in individuals with Clostridium Difficile Infection


		Celiac disease (%) N=143,180	No celiac disease (%) N=80,741,220
Age	18-65	9,7340 (67.9)	47,893,510 (59.3)
	>65	39,400 (27.5)	21,266,990 (26.2)
Sex	Male	1,640 (1.15)	189,850 (0.24)
Race	Caucasian	117,430 (82.0)	42,011,260 (52.0)
Comorbidities	Clostridium difficile	2,050 (1.43)	231,830 (0.29)
	Hypertension	45,710 (31.9)	14,183,650 (17.5)
	Type 2 Diabetes	20,050 (13.9)	5,651,930 (6.9)
	Hyperlipidemia	51,170 (35.7)	11,782,380 (14.5)
	Smoking	19,480 (13.6)	3,874,810 (52.0)
Medications	PPI	54,790 (38.27)	86,37,610 (10.70)

Table: Table 1: Baseline Catachrestic of Study Population.

Disclosures:

Eduard Krishtopaytis indicated no relevant financial relationships.

Ashraf Almomani indicated no relevant financial relationships.

Prabhat Kumar indicated no relevant financial relationships.

Somtochukwu Onwuzo indicated no relevant financial relationships.

Antoine Boustany indicated no relevant financial relationships.

Asif Hitawala indicated no relevant financial relationships.

Dana Alshaikh indicated no relevant financial relationships.

Imad Asaad indicated no relevant financial relationships.

Osama Abu-Shawer indicated no relevant financial relationships.

Eduard Krishtopaytis, MD¹, Ashraf Almomani, MD², Prabhat Kumar, MD², Somtochukwu Onwuzo, MD², Antoine Boustany, MD, MPH², Asif Hitawala, MD³, Dana Alshaikh, MD⁴, Imad Asaad, MD⁵, Osama Abu-Shawer, MD, MS⁶. B0642 - Celiac Disease Patients Have Higher Risk for Clostridium difficile Infections: A Population-Based Study, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.