1. Impact of Clostridium difficile on Inflammatory Bowel Disease
Mazen Issa, Aravind Vijayapal, Mary Beth Graham, Dawn B. Beaulieu, Mary F. Otterson, Sarah Lundeen, Susan Skaros, Lydia R. Weber, Richard A. Komorowski, Josh F. Knox, Jeanne Emmons, Jasmohan S. Bajaj, David G. Binion 
Clinical Gastroenterology and Hepatology 
Volume 5, Issue 3, Pages (March 2007)
DOI: /j.cgh
Copyright © 2007 AGA Institute Terms and Conditions

2. Figure 1
Increasing number of C difficile–infected patients with IBD (Crohn’s disease, ulcerative colitis) followed at a tertiary referral IBD center between 2000–2005. When normalized to the IBD Center patient population, the percentage of C difficile–infected patients increased from 1.8% in 2004 to 4.6% in 2005 (P < .01). All patients were documented to have positive stool ELISA testing for C difficile.
Clinical Gastroenterology and Hepatology 2007 5, DOI: ( /j.cgh )
Copyright © 2007 AGA Institute Terms and Conditions

3. Figure 2
IBD patients constitute an increasing percentage of patients with C difficile infection within a single tertiary referral institution. Increasing proportion of IBD patients with C difficile infection compared with the total number of C difficile–infected patients (both inpatients and outpatients combined) at a single referral hospital and its affiliated outpatient clinics between 2000–2005. The percentage of IBD patients with C difficile increased from 7% of the total number of infections in 2004 to 16% of the total number of C difficile cases in 2005 (P < .01).
Clinical Gastroenterology and Hepatology 2007 5, DOI: ( /j.cgh )
Copyright © 2007 AGA Institute Terms and Conditions

4. Figure 3
Increasing number of hospitalizations in IBD patients with C difficile infection between 2000–2005. Sixty-three percent of the IBD patients infected with C difficile in 2004 and 2005 required hospitalization during their management.
Clinical Gastroenterology and Hepatology 2007 5, DOI: ( /j.cgh )
Copyright © 2007 AGA Institute Terms and Conditions

5. Figure 4
C difficile infection in IBD patients does not demonstrate classic endoscopic features of pseudomembranous colitis. The upper endoscopic photographs demonstrate the colonoscopic appearance of C difficile in patients with no history of IBD, demonstrating classic pseudomembranes that coalesce in the center picture. The endoscopic finding of pseudomembranous colitis in a patient with antibiotic-associated diarrhea is virtually pathognomonic for C difficile infection. Other endoscopic features associated with C difficile infection include erythema, edema, friability, and erosions. The lower panel of endoscopic photographs demonstrates the appearance of C difficile infection in patients with ulcerative colitis (left 2 pictures) and Crohn’s colitis (right 2 pictures). No classic pseudomembranes were identified in any of the IBD patients evaluated with endoscopy at our center during the study period. Nonspecific findings including mucopus, edema, erythema, and friability in the setting of active colitis were most commonly encountered.
Clinical Gastroenterology and Hepatology 2007 5, DOI: ( /j.cgh )
Copyright © 2007 AGA Institute Terms and Conditions

6. Figure 5
Histologic features of C difficile infection in patients with IBD fail to demonstrate exudation of fibrinopurulent pseudomembrane. Classic “volcano” eruption of inflammatory cells, fibrin, mucin, and necrotic debris is seen in the histologic appearance of a non-IBD patient with C difficile colitis on the left photomicrograph. In contrast, the histologic appearance of C difficile in a patient with Crohn’s colitis on the right fails to demonstrate classic fibrinopurulent exudate and instead shows active colitis with extensive cryptitis, crypt abscesses, leukocytic infiltration, and erosions. No inflammatory pseudomembranes are seen on histology. Hematoxylin-eosin staining in both slides.
Clinical Gastroenterology and Hepatology 2007 5, DOI: ( /j.cgh )
Copyright © 2007 AGA Institute Terms and Conditions