Risk of serious infection even with low-activity bowel disease

New study. Inflammatory bowel disease, IBD, is an independent risk factor for serious infections, even at very low levels of intestinal inflammation. This is what a study conducted at the University of Gothenburg showed.

IBD is a collective name for chronic inflammatory bowel diseases with an incidence in the population of about 0.5 percent. Inflammatory bowel disease (IBD) mainly includes ulcerative colitis and Crohn’s disease. Unlike IBS, irritable bowel syndrome, inflammatory bowel disease causes pronounced damage to the intestinal mucosa.

Inflammatory bowel disease (IBD) is characterized by symptoms of relapse. Sometimes, periods of high disease activity are followed by longer periods of low or no disease activity. However, it has not been clear to what extent IBD patients with low disease activity are also at increased risk for serious infections, including sepsis.

The current study, published in the Journal of Clinical Gastroenterology and Hepatology, included data on 55,626 individuals diagnosed with inflammatory bowel disease. Serious infection means infection that requires hospitalization.

The difference between healing and non-curing

The results showed that during periods of low disease activity but active intestinal inflammation, or so-called microscopic inflammation, there was an increased risk of developing serious infections compared to periods when the intestinal mucosa was microscopically healed.

Regarding microscopic infections, the number of serious infections reached 4.62 per 100 people per year. The corresponding figure for microscopically healed mucosa was 2.53. This corresponded to a 59% relative increase in the risk of residual microscopic enteritis, when results were adjusted for various confounding factors.

Interestingly, the results remained true even after adjusting for the IBD medications that patients were prescribed, and were similar regardless of age group, gender, and education level.

The study’s first name and corresponding author is Karl Myrld, a lecturer in pediatrics at the Sahlgrenska Academy, University of Gothenburg and chief physician at the Department of Gastroenterology and Liver at the Queen Silvia Children’s Hospital in Gothenburg.

Healing provides important protection

– What we were able to show is that even during periods of microscopic inflammation in the intestine, IBD patients are more likely to develop serious infections including sepsis, compared to periods when they have a microscopically healed mucosa. This also applies to patients who clinically appear to have low-activity disease, but beneath the surface have microscopic inflammation in the intestine, he says.

The results suggest that if we can achieve complete healing of the intestinal mucosa in inflammatory bowel disease, the risk of serious infections can be reduced. It is important that today’s serious infections contribute to increased morbidity and mortality in both children and adults with inflammatory bowel disease, concludes Karl Myrld.

The study results are based on data from a national cohort (ESPRESSO) with information from Swedish health registries, the Inflammatory Bowel Disease Quality Registry (SWIBREG) on people in Sweden diagnosed with IBD in the years 1990-2016. These data were linked to data from microscopic intestinal examinations of patients with inflammatory bowel disease.

Title: Histological activity in inflammatory bowel disease and the risk of serious infections: a national study, https://doi.org/10.1016/j.cgh.2023.10.013

Written by: Margarita Gustafsson Kubista