Clostridium difficile in Relapse of Inflammatory Bowel Disease

42 INTRODUCTION Despite the availability of a growing number of therapeutic options for the treatment of inflammatory bowel disease (IBD), patients in remission remain at constant risk of disease relapse. Clinically, it can be difficult to distinguish between diarrheal relapses of IBD and the presence of enteric infection. Several microorganisms can be seen in association with relapse, including Clostridium difficile, Campylobacter, Salmonella and Shigella species, Escherichia coli, Entamoeba histolytica, and cytomegalovirus. Clostridium difficile is particularly common in patients with a history of recent antibiotic use and will be the focus of this review. The significance of secondary infectious causes such as Clostridium difficile, as well as the importance of routine stool examination in patients with relapsed IBD remains controversial.