DIAGNOSTIC AND THERAPEUTIC CHALLENGES OF RECURRENT CLOSTRIDIOIDES DIFFICILE INFECTION IN ACUTE ULCERATIVE COLITIS

Аннотация

Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by continuous mucosal inflammation beginning in the rectum and extending proximally along the colon. The disease most commonly presents in young adults between 15 and 35 years of age, although a secondary incidence peak occurs after the age of 60. Increasing prevalence of UC has been associated with urbanization, Western dietary patterns, antibiotic exposure, and alterations of the intestinal microbiota.

Despite relatively low mortality, UC is a lifelong disease that significantly reduces quality of life. Patients frequently experience relapsing-remitting symptoms including diarrhea, abdominal pain, urgency, and fatigue. In addition to intestinal manifestations, many patients develop extraintestinal complications involving joints, skin, and eyes. Long-standing disease also increases the risk of colorectal carcinoma.

Patients with UC are particularly susceptible to superimposed intestinal infections. Among these, Clostridioides difficile infection (CDI) represents one of the most clinically significant complications. Epidemiological studies suggest that UC patients have a two- to four-fold increased risk of CDI compared with the general population. Furthermore, immunosuppressive therapy—especially corticosteroids—may increase the risk of recurrence and worsen disease outcomes.

Distinguishing between a UC flare and CDI-associated colitis can be challenging because both conditions present with similar clinical features. Accurate and timely diagnosis is therefore essential to guide appropriate therapeutic strategies.