Microscopic inflammation in IBD linked to higher risk of serious infections

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Inflammatory bowel disease (IBD) is an independent risk factor for serious infections, even with very low levels of gastrointestinal inflammation. This information has emerged in a study of the University of Gothenburg.

IBD is an umbrella term for chronic inflammatory bowel disease, with a population prevalence of approximately 0.5%. The main types of IBD are ulcerative colitis and Crohn’s disease. Unlike irritable bowel syndrome (IBS), IBD results in visible damage to the intestinal mucous membrane.

IBD is characterized by intermittent symptoms. Periods of high disease activity are sometimes followed by long periods of low or no activity. However, it has become clear how IBD patients with low disease activity are 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 people diagnosed with IBD. A ‘serious infection’ is defined as an infection requiring hospitalization.

Difference Between Curing and Curing

The results showed that periods of low disease activity but active gastrointestinal inflammation, known as microscopic inflammation, had a higher risk of developing serious infections than periods of microscopically healed intestinal mucosa.

For microscopic inflammation, the number of serious infections per 100 person-years was 4.62. The corresponding figure for microscopically healed mucosa was 2.53. This corresponds to a 59% relative risk increase for residual microscopic gastrointestinal inflammation when the results are adjusted for various confounders.

Importantly, the results held true even after adjusting for prescribed IBD medications and were similar regardless of age, sex, and education level.

The study’s first name and corresponding author is Karl Marild, an associate professor of pediatrics at the Sahlgrenska Academy University in Gothenburg and a consultant at the Gastrointestinal and Liver Clinic at the Queen Silvia Children’s Hospital in Gothenburg.

Cure provides important protection

We have shown that even during periods of microscopic intestinal inflammation, IBD patients are at increased risk of serious infections, including sepsis, when they have a microscopically healed mucosa. This is also true in patients who have less-active disease in clinical terms, but who have microscopic intestinal inflammation beneath the surface.

The results indicate that a fully healed intestinal mucosa in IBD may reduce the risk of serious infections. This is important, as severe infections currently contribute to increased morbidity and mortality in both children and adults with IBD.”

Karl Marild, Associate Professor of Pediatrics, Sahlgrenska Academy University of Gothenburg

The study results are based on data from a national cohort with data from the Swedish Health Register (ESPRESSO) and from the Quality Register for IBD (SWIBREG) of people in Sweden with IBD between 1990 and 2016. Data from microscopic intestinal examination of patients with IBD.


Journal Reference:

Marold, K., etc (2023) Histological activity and risk of serious infections in inflammatory bowel disease: a nationwide study. Clinical Gastroenterology and Hepatology. doi.org/10.1016/j.cgh.2023.10.013.

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