Clostridioides difficile infection- associated functional bowel disorder: A 3-year cohort study

Abstract Background Recurrent diarrhea after an episode of Clostridioides difficile infection (CDI) is common although not always secondary to recurrent disease. Bacterial and viral gastroenteritis has been associated with post-infectious functional bowel disorders (FBD). We aimed to compare characteristics of patients diagnosed with CDI-associated FBD and patients diagnosed with initial or recurrent CDI alone. Methods This is a retrospective review of the electronic medical records of patients referred to the Complicated C. difficile Clinic at the University of Virginia Health from March 2020 to January 2023. The characteristics of patients we studied included demographics, risk factors, and outcomes. Results Of 159 patients seen at the clinic, 44 (27.7%) referred for recurrent CDI had symptoms of FBD; 90 (56.6%) had symptoms of CDI alone. Compared to patients with CDI only, patients with CDI- associated FBD were younger (P = 0.001), more likely female (P = 0.029), with fewer comorbidities (P 0.001), and more frequent history of anxiety (P 0.001) and depression (P = 0.003). In a multiple regression model, FBD remained associated with fewer comorbidities (P = 0.032). At 3-months, patients with FBD were less frequently well (P = 0.039) and more frequently continued to have gastrointestinal symptoms (P 0.001) than patients with CDI alone. Conclusions CDI- associated FBD is prevalent but may be misdiagnosed as solely CDI recurrence, contributing to incomplete resolution of symptoms despite anti-C. difficile treatments.