C0637 - Risk of Clostridioides difficile Infection in Patients With Celiac Disease: Insight From a U.S.-Based Population Study

Monday, October 24, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Arjun Chatterjee, MD

Cleveland Clinic Foundation
Cleveland, OH

Arjun Chatterjee, MD¹, Motasem Alkhayyat, MD¹, Manik Aggarwal, MD¹, Andrew Ford, MD¹, Khaled Alsabbagh Alchirazi, MD¹, Jason Nasser, MD¹, Claire Jansson-Knodell, MD¹, Alberto Rubio Tapia, MD²
¹Cleveland Clinic Foundation, Cleveland, OH; ²Cleveland Clinic, Cleveland, OH

Introduction: Little is known about the association between Clostridioides difficile infection (CDI) and celiac disease. The aim of the study is to describe the risk of CDI in patients with celiac disease and to describe the clinical outcomes in patients with celiac and CDI.

Methods: We queried a commercial database (Explorys IncTM, Cleveland, OH, United States), and obtained an aggregate of electronic health record data from 26 major integrated United States healthcare systems comprising 360 hospitals in the United States from 2017 to 2022. Diagnoses were organized into the Systematized Nomenclature of Medicine Clinical Terms (SNOMED–CT) hierarchy. We compared the incidence of new CDI among patients with celiac disease versus those without celiac disease (controls). Univariate and multivariate analyses were performed on the data, and associations were reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI).

Results: We identified 90,060 patients with celiac disease and 25,807,720 controls. The incidence of new CDI was 1.31% (1,180) in celiac disease patients, and 0.35% (92,330) in controls, yielding an odds ratio (OR) of 3.69 (95% CI 3.49-3.91; P< 0.0001). Treatment and clinical outcomes were not significantly different. After controlling for common CDI risk factors, the multivariate analysis model uncovered that celiac patients were more likely to develop CDI OR: 1.34 (95% CI: 1.2-1.4, P < 0.0001) compared to controls. Table 1

Discussion: In a large US population-based study, patients with celiac disease had a significantly higher incidence of CDI than controls. Clinical outcomes were similar between the groups. Clinicians should be vigilant and consider CDI in celiac patients with new or recurrent diarrhea.

Demographics	Celiac Patients (n=90,060)	Control Patients (n=25,807,720)
Age 18-65 years (%)	65,220 (72.4%)	18,331,970 (71%)
Age >65 years (%)	24,840 (27.6%)	7,475,750 (29%)
Female (%)	66,800 (74.2%)	13,219,060 (51.2%)
Race: Caucasian (%)	73540 (81.7%)	14,072,590 (54.5%)
Smoker (%)	15,120 (16.8%)	2,327,950 (9%)
Alcohol abuse (%)	2,530 (2.8%)	552,010 (2.1%)
Hypertension (%)	42,250 (46.9%)	8,063,140 (31.2%)
Diabetes (%)	25,560 (28.4%)	3,446,990 (13.4%)
Obesity (%)	26,170 (29.1%)	3,535,170 (13.7%)
Clostridioides difficile infection management and clinical outcomes
Developed Clostridioides difficile infection*	1,180 (1.31%)	92,330 (0.35%)
Treated with metronidazole	820 (69%)	56,490 (61.1%)
Treated with vancomycin	770 (65.2%)	55,270 (59%)
Treated with fidaxomicin	70 (5.9%)	4,370 (4.7%)
Colectomy**	10 (0.84%)	970 (1.05%)
Multivariable model with Clostridioides difficile infection being the outcome
Risk Factors	Odds Ratio	95% CI; p-value
Age ≥65 yr vs < 65yr	2.988	2.962-3.014; < 0.0001
Gender (female vs male)	1.194	1.184-1.204; < 0.0001
Race (Caucasian vs rest)	1.483	1.467-1.498; < 0.0001
Antibiotics	3.657	3.6-3.7; < 0.0001
Acid suppressive therapy***	4.268	4.224-4.313; < 0.0001
Inflammatory bowel disease	6.031	5.93-6.13; < 0.0001
Celiac disease	1.342	1.284-1.403; < 0.0001

Table: Table 1
*1st occurrence of CDI after celiac diagnosis
**Colectomy performed within 60 days of CDI diagnosis (excluded patients with a history of IBD, ischemic colitis, and neoplasia of the colon)
***Acid suppressive therapy includes prior use of proton pump inhibitors or H2 blockers

Disclosures:

Arjun Chatterjee indicated no relevant financial relationships.

Motasem Alkhayyat indicated no relevant financial relationships.

Manik Aggarwal indicated no relevant financial relationships.

Andrew Ford indicated no relevant financial relationships.

Khaled Alsabbagh Alchirazi indicated no relevant financial relationships.

Jason Nasser indicated no relevant financial relationships.

Claire Jansson-Knodell: Clearpoint Neuro Inc – Stock-publicly held company(excluding mutual/index funds). Dariohealth Corp Com – Stock-publicly held company(excluding mutual/index funds). DermTech Inc – Stock-publicly held company(excluding mutual/index funds). DiaMedica Therapeutics Inc. – Stock-publicly held company(excluding mutual/index funds). Exact Sciences – Stock-publicly held company(excluding mutual/index funds). Inari – Stock-publicly held company(excluding mutual/index funds). Nano-X imaging ltd – Stock-publicly held company(excluding mutual/index funds). Outset medical – Stock-publicly held company(excluding mutual/index funds). PavMed – Stock-publicly held company(excluding mutual/index funds). Transmedics Group Inc – Stock-publicly held company(excluding mutual/index funds).

Alberto Rubio Tapia indicated no relevant financial relationships.

Arjun Chatterjee, MD¹, Motasem Alkhayyat, MD¹, Manik Aggarwal, MD¹, Andrew Ford, MD¹, Khaled Alsabbagh Alchirazi, MD¹, Jason Nasser, MD¹, Claire Jansson-Knodell, MD¹, Alberto Rubio Tapia, MD². C0637 - Risk of Clostridioides difficile Infection in Patients With Celiac Disease: Insight From a U.S.-Based Population Study, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.