Intestinal Research

Original Articles

Analysis of gut microbiota in super donors for fecal microbiota transplantation and isolated gut commensal bacteria of inhibition against Clostridioides difficile: Ki Sung Kang, Gee Hyeun Choi, Yu Jin Kim, Won Suk Lee, Do Eun Lee, Min Yeong Kim, Hyuk Yoon, Dong Ho Lee; Received August 18, 2025 Accepted November 25, 2025 Published online February 4, 2026; DOI: https://doi.org/10.5217/ir.2025.00179 [Epub ahead of print]

Abstract PDF: Background/Aims
Fecal microbiota transplantation (FMT) is increasingly recognized as an alternative to antibiotics for treating recurrent Clostridioides difficile infection. The success of FMT heavily depends on the appropriate selection of donors, encompassing factors such as diet patterns, lifestyle, environmental exposures, and intestinal microbiota diversity.
Methods
A potential super donor was identified from 5 healthy adults and provided stool samples periodically over 2 years (2021–2022). The samples underwent 16S rRNA sequencing via the Illumina MiSeq platform, and microbial diversity was analyzed using QIIME 2 in comparison with 152 healthy individuals.
Results
The stool microbiome composition of the potential super donor remained stable without significant changes over a 2-year period. Both alpha and beta diversity analyses revealed significant differences between the super donor and the 152 healthy individuals. The super donor exhibited significantly higher microbial diversity based on alpha diversity metrics (P< 0.0001) and distinct compositional profiles as shown by beta diversity. Linear discriminant analysis effect size (LEfSe) analysis indicated that Faecalibacterium and Prevotella strains comprised a significant proportion, with notable differences in relative abundance patterns (P< 0.05). Furthermore, 7 bacterial species were isolated from the super donor, all of which demonstrated inhibitory effects on the growth of C. difficile in vitro.
Conclusions
These findings suggest that selecting donors with specific microbiota profiles, particularly those exhibiting higher microbial diversity, may potentially contribute to the inhibition of C. difficile, and further clinical studies are warranted to validate these findings.

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Infection

The impact of the quality improvement program on Clostridioides difficile infection management: a quasi-experimental study: Jung Yun Lee, Jae-Ki Choi, Tae-Geun Gweon, Young Eun An, Hyo Suk Kim, Jae Hyuck Chang, Tae Ho Kim, Chang Whan Kim, Young-Seok Cho; Intest Res 2025;23(4):551-558. Published online October 28, 2025; DOI: https://doi.org/10.5217/ir.2025.00137

Abstract PDF PubReader ePub: Background/Aims
Clostridioides difficile infection (CDI) is a major cause of nosocomial diarrhea. This study aimed to implement a quality improvement program to expedite proper CDI treatment, including discontinuing laxatives and associated antibiotics.
Methods
Stool test results positive for CDI were automatically sent via text message to the quality improvement team, specialists in CDI management. The quality improvement team played an advisory role in this treatment. The outcome of this study was the competency of CDI treatment within 24 hours of stool test reporting. Competency was investigated using 3 different models: Model 1, initiation of CDI treatment within 24 hours of positive stool test report; Model 2, Model 1 criteria met with no concurrent laxative use; and Model 3, Model 2 criteria met with no concurrent associated antibiotics. Competency rates were compared between pre- and post-intervention periods (1 year each). Analyses were performed for inpatients with CDI.
Results
In total, 310 inpatients with CDI (129 pre-intervention, 181 post-intervention) were included in this study. The rates of competency for Model 1 (85.3% vs. 95.6%, p= 0.006), Model 2 (81.4% vs. 92.3%, p= 0.004), and Model 3 (35.7% vs. 56.4%, p< 0.001) in the post-intervention group were higher to those in the pre-intervention group.
Conclusions
Quality improvement program enhanced the quality of CDI treatment in terms of prompt treatment and discontinuation of concomitant laxatives and associated antibiotics. (cris.nih.go.kr; KCT0005892)

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IBD

Incidence rates for hospitalized infections, herpes zoster, and malignancies in patients with ulcerative colitis in Japan: an administrative health claims database analysis: Katsuyoshi Matsuoka, Kanae Togo, Noritoshi Yoshii, Masato Hoshi, Shoko Arai; Intest Res 2023;21(1):88-99. Published online March 11, 2022; DOI: https://doi.org/10.5217/ir.2021.00154

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Patients with ulcerative colitis (UC) are at an increased risk of certain infections and malignancies compared with the general population. Incidence rates (IRs) of hospitalized infections, herpes zoster (HZ), and malignancies in patients with UC, stratified by treatment, in Japan were estimated.
Methods
This retrospective study identified patients with UC treated with corticosteroids, immunosuppressants, or tumor necrosis factor inhibitors (TNFi) from 2 administrative databases (Japan Medical Data Center [JMDC] and Medical Data Vision [MDV]). IRs (unique patients with events per 100 patient‐years) were estimated for hospitalized infections, HZ, and malignancies, between June 2010 and May 2018.
Results
Among 6,033 MDV patients with UC receiving corticosteroids, immunosuppressants, or TNFi, IRs (95% confidence intervals) were: hospitalized infections, 1.73 (1.52–1.93); HZ, 1.00 (0.85–1.16), and malignancies, 1.48 (1.29–1.66). Among 958 JMDC patients with UC receiving corticosteroids, immunosuppressants, or TNFi, IRs (95% confidence intervals) were: HZ, 1.82 (1.27–2.37) and malignancies, 1.35 (0.87–1.82). In both cohorts, IRs of malignancies were generally similar among patients receiving immunosuppressants, TNFi, or combination therapy (immunosuppressants and TNFi); this was also true for IRs of hospitalized infections and HZ in the MDV cohort. IRs of hospitalized infections, HZ, and malignancies were higher in patients receiving calcineurin inhibitors compared with immunosuppressants or TNFi, in both cohorts.
Conclusions
IRs of hospitalized infections, HZ, and malignancies among patients with UC were generally similar regardless of UC treatment, except for calcineurin inhibitors.

Citations

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Epidemiological study of colovesical fistula as a complication of colonic diverticulitis in Japan: an analysis of claims data
Shunsuke Omotaka, Hiroki Den, Takenori Yamauchi, Ryota Tokunaga, Suguru Ogihara, Masayuki Isozaki, Takahiro Hobo, Noboru Yokoyama, Haruhiro Inoue, Akatsuki Kokaze
Surgery Today.2026;[Epub] CrossRef
Clinical characteristics of patients with difficult-to-treat ulcerative colitis: a nested case-control study using a Japanese claims database
Katsuyoshi Matsuoka, Ataru Igarashi, Noriko Sato, Naomi Mizuno, Manabu Ishii, Masato Iizuka, Katsuhiko Iwasaki, Ayako Shoji, Tadakazu Hisamatsu
Intestinal Research.2026; 24(1): 103. CrossRef
Assessment of incidence and risk factors of COVID-19-associated candidemia using diagnosis procedure combination data
Waki Imoto, Yasutaka Ihara, Tsubasa Bito, Ryota Kawai, Hiroki Namikawa, Wataru Shibata, Yukihiro Kaneko, Ayumi Shintani, Hiroshi Kakeya
Journal of Infection and Chemotherapy.2025; 31(5): 102689. CrossRef
Post-marketing surveillance of tofacitinib in patients with ulcerative colitis in Japan: a final report of safety and effectiveness data
Katsuyoshi Matsuoka, Satoshi Motoya, Takayuki Yamamoto, Minoru Matsuura, Toshimitsu Fujii, Shinichiro Shinzaki, Yohei Mikami, Shoko Arai, Junichi Oshima, Yutaka Endo, Hirotoshi Yuasa, Masato Hoshi, Keiko Sato, Tadakazu Hisamatsu
Journal of Gastroenterology.2025; 60(8): 979. CrossRef
Herpes zoster infection in patients with inflammatory bowel disease
Dong Hyun Kim, Sang-Bum Kang
The Korean Journal of Internal Medicine.2025; 40(3): 347. CrossRef
Impact of coronavirus disease on the incidence rate of methicillin-resistant Staphylococcus aureus among hospitalized patients with lung cancer: a nationwide retrospective cohort study in Japan
Yasutaka Ihara, Hisafumi Kihara, Waki Imoto, Naoto Okada, Hiroshi Kakeya, Yukihiro Kaneko
Journal of Pharmaceutical Health Care and Sciences.2025;[Epub] CrossRef
Safety of Biologics and Small Molecules for Inflammatory Bowel Diseases in Organ Transplant Recipients
Ga Hee Kim, Minjun Kim, Kyuwon Kim, Jung-Bin Park, Ji Eun Baek, June Hwa Bae, Seung Wook Hong, Sung Wook Hwang, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Sang Hyoung Park
Yonsei Medical Journal.2024; 65(5): 276. CrossRef
Risk Factors of Pneumocystis jirovecii Pneumonia in Patients with Inflammatory Bowel Disease: A Nationwide Population-Based Study
Jiyoung Yoon, Seung Wook Hong, Kyung-Do Han, Seung-Woo Lee, Cheol Min Shin, Young Soo Park, Nayoung Kim, Dong Ho Lee, Joo Sung Kim, Hyuk Yoon
Gut and Liver.2024; 18(3): 489. CrossRef
Incidence and Potential Risk Factors of Human Cytomegalovirus Infection in Patients with Severe and Critical Coronavirus disease 2019
Waki Imoto, Takumi Imai, Ryota Kawai, Yasutaka Ihara, Yuta Nonomiya, Hiroki Namikawa, Koichi Yamada, Hisako Yoshida, Yukihiro Kaneko, Ayumi Shintani, Hiroshi Kakeya
Journal of Infection and Chemotherapy.2024;[Epub] CrossRef
Incidence and risk factors for coronavirus disease 2019‐associated pulmonary aspergillosis using administrative claims data
Waki Imoto, Yasutaka Ihara, Takumi Imai, Ryota Kawai, Koichi Yamada, Yukihiro Kaneko, Ayumi Shintani, Hiroshi Kakeya
Mycoses.2024;[Epub] CrossRef
Safety and effectiveness of tofacitinib in Korean adult patients with ulcerative colitis: post-marketing surveillance study
Hyuk Yoon, Byong Duk Ye, Sang-Bum Kang, Kang-Moon Lee, Chang Hwan Choi, Joo-young Jo, Juwon Woo, Jae Hee Cheon
BMC Gastroenterology.2024;[Epub] CrossRef
Validity of claims-based diagnoses for infectious diseases common among immunocompromised patients in Japan
Ryota Hase, Daisuke Suzuki, Cynthia de Luise, Haoqian Chen, Edward Nonnenmacher, Takakazu Higuchi, Kayoko Katayama, Mitsuyo Kinjo, Sadao Jinno, Toshitaka Morishima, Naonobu Sugiyama, Yoshiya Tanaka, Soko Setoguchi
BMC Infectious Diseases.2023;[Epub] CrossRef
Vaccination strategies for Korean patients with inflammatory bowel disease
Yoo Jin Lee, Eun Soo Kim
The Korean Journal of Internal Medicine.2022; 37(5): 920. CrossRef

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Inflammatory Bowel Diseases

Is there a correlation between infliximab trough levels and the development of adverse events in patients with inflammatory bowel disease?: Eirini Theodoraki, Eleni Orfanoudaki, Kalliopi Foteinogiannopoulou, Evangelia Legaki, Maria Gazouli, Ioannis E. Koutroubakis; Intest Res 2021;19(4):461-467. Published online August 18, 2020; DOI: https://doi.org/10.5217/ir.2020.00042

Abstract PDF PubReader ePub

Background/Aims
The measurement of infliximab trough levels (IFX-TLs) in patients with inflammatory bowel disease (IBD) is performed to optimize treatment. However, the association between the development of adverse events (AEs) and IFX-TLs has not been sufficiently studied thus far. To investigate the possible association of IFX-TLs with AEs in Greek patients with IBD receiving maintenance treatment with IFX.
Methods
A retrospective analysis of the registry data of the Gastroenterology Department of the University Hospital of Heraklion, from IBD patients with at least one available IFX-TL measurement during the years 2016 to 2017 was conducted. AEs reported 4 months before and 4 months after the measured IFX-TLs were recorded. The IFX-TLs of patients with or without AEs were compared.
Results
Of a total of 83 IBD patients (61 Crohn’s disease [73%]; 52 men [63%]; mean age ± standard deviation, 43.3 ± 16.0 years), 147 measurements of IFX-TLs were available (median 4.69 μg/ mL [1.32–9.16]), and 99 AEs (67.3%, 14 severe) were registered. The median IFX-TL of patients with AEs was 5.79 μg/mL (1.36– 10.25), higher than the median IFX-TL of patients without AEs (3.40 μg/mL [1.30–5.92]), but the difference was not significant (P= 0.97). The presence of infections or dermatologic reactions was not correlated with IFX-TLs. There was no difference in the prevalence of the total AEs (66.7% vs. 73.3%, P= 0.77) or in the analysis of AEs by group between patients with IFX-TLs ≥ 15 μg/ mL and patients with IFX-TLs < 15 μg/mL.
Conclusions
IFX-TLs are not significantly associated with the development of AEs in IBD patients receiving maintenance treatment with IFX.

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Identifying risk factors of anti‐TNF induced skin lesions and other adverse events in paediatric patients with inflammatory bowel disease
Karen van Hoeve, Debby Thomas, Tom Hillary, Ilse Hoffman, Erwin Dreesen
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Daniela Kosorínová, Pavlína Suchá, Zuzana Havlíčeková, Marek Pršo, Pavol Dvoran, Peter Bánovčin
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Effect of antinuclear antibodies on pharmacokinetics of anti-TNF therapy in patients with inflammatory bowel disease
Eirini Theodoraki, Eleni Orfanoudaki, Kalliopi Foteinogiannopoulou, Nikolaos-Panagiotis Andreou, Maria Gazouli, Ioannis E. Koutroubakis
International Journal of Colorectal Disease.2022; 37(3): 639. CrossRef
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Jihye Park, Jae Hee Cheon
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Ji Young Chang, Jae Hee Cheon
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IBD

Is Clostridium difficile infection a real threat in patients with ulcerative colitis? A prospective, multicenter study in Korea: Dae Bum Kim, Kang-Moon Lee, Sang Hyoung Park, You Sun Kim, Eun Soo Kim, Jun Lee, Sung-Ae Jung, Geom Seog Seo, Ji Min Lee; Intest Res 2018;16(2):267-272. Published online April 30, 2018; DOI: https://doi.org/10.5217/ir.2018.16.2.267

Abstract PDF PubReader ePub

Background/Aims

Clostridium difficile infection (CDI) has been reported to be a cause of flare-ups in patients with ulcerative colitis (UC). We evaluated the prevalence and clinical outcomes of CDI in patients with UC hospitalized for flare-ups.

Methods

This was a prospective, multicenter study including 7 academic teaching hospitals in Korea. All consecutive patients with UC admitted for disease flare-up were enrolled. We detected the presence of CDI by using enzyme immunoassay, real-time polymerase chain reaction (RT-PCR) for toxin genes, and sigmoidoscopy.

Results

Eighty-one consecutive patients with UC were enrolled from January 2014 to December 2015. Among 81 patients, 8 (9.9%) were diagnosed with CDI. Most of the cases were identified by RT-PCR. Enzyme immunoassay was positive in 3 of 8 patients, and only 1 had typical endoscopic findings of pseudomembranous colitis. There were no differences in demographic data, length of hospital stay, or colectomy rate between patients with and without CDI.

Conclusions

CDI was not a rare cause of flare-up in patients with UC in Korea. However, CDI did not appear to affect the course of UC flare-up in Korean patients. RT-PCR was sensitive in detecting CDI and can be considered a diagnostic tool in patients with UC flare-up.

Citations

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ECCO consensus on management of inflammatory bowel disease in low- and middle-income countries
Alaa El-Hussuna, Almuthe Christina Hauer, Tarkan Karakan, Valerie Pittet, Henit Yanai, Jalpa Devi, Jesus K Yamamoto-Furusho, Ali Reza Sima, Hailemichael Desalegn, Mutaz Idrees Sultan, Vishal Sharma, Hany Shehab, Lamya Mrabti, Natalia Queiroz, Anuraag Jena
Journal of Crohn’s and Colitis.2026;[Epub] CrossRef
Association of Clostridium difficile infection with clinical outcomes of patients with inflammatory bowel disease: A meta-analysis
Hai-Xin Qi, Qi Wang, Gui-Qun Zhou
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
Impact of Clostridioides difficile Infection on the Outcome of Severe Flare of Ulcerative Colitis
Anupam Kumar Singh, Siddharth Shukla, Ritesh Acharya, Chhagan Lal Birda, Pramod Kumar Sah, Shravya Singh, Vaneet Jearth, Jimil Shah, Ashish Agarwal, Arun Kumar Sharma, Yashwant Raj Sakaray, Saroj Kant Sinha, Usha Dutta
Journal of Clinical Gastroenterology.2025;[Epub] CrossRef
Early predictors of rescue therapy and colectomy in acute severe ulcerative colitis
Samuel Jun Ming Lim, Kaina Chen, Yi Yuan Tan, Shu Wen Tay, Thomson Chong Teik Lim, Ennaliza Salazar, Webber Pak-Wo Chan, Malcolm Teck Kiang Tan
Singapore Medical Journal.2025; 66(8): 449. CrossRef
A positive Clostridioides difficile test does not impact outcomes in hospitalized patients with acute severe ulcerative colitis
Geethanjali Rajagopal, Raghavendra Paknikar, Zifeng Deng, Sujaata Dwadasi, Donald V. Goens, Maryam Zafer, Russell D. Cohen, Atsushi Sakuraba, David T. Rubin, Sushila Dalal, Dejan Micic, Joel Pekow
Therapeutic Advances in Gastroenterology.2025;[Epub] CrossRef
Low prevalence of Clostridioides difficile infection in acute severe ulcerative colitis: A retrospective cohort study from northern India
Sandeep Mundhra, David Thomas, Saransh Jain, Pabitra Sahu, Sudheer Vuyyuru, Peeyush Kumar, Bhaskar Kante, Rajesh Panwar, Peush Sahni, Rama Chaudhry, Prasenjit Das, Govind Makharia, Saurabh Kedia, Vineet Ahuja
Indian Journal of Gastroenterology.2023; 42(3): 411. CrossRef
The Prevalence and Risk Factors of Clostridioides difficile Infection in Inflammatory Bowel Disease: 10-Year South Korean Experience Based on the National Database
Eun Mi Song, Arum Choi, Sukil Kim, Sung Hoon Jung
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Clostridioides Infection in Patients with Inflammatory Bowel Disease
Mi Rae Lee, Eun Soo Kim
The Korean Journal of Gastroenterology.2022; 80(2): 66. CrossRef
Clostridium difficile in ulcerative colitis; a retrospective study
O. V. Knyazev, A. V. Kagramanova, M. E. Chernova, I. A. Koroleva, A. I. Parfenov
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Statement

IBD

Evidence-based consensus on opportunistic infections in inflammatory bowel disease (republication): Intest Res 2018;16(2):178-193. Published online April 30, 2018; DOI: https://doi.org/10.5217/ir.2018.16.2.178

Abstract PDF PubReader ePub

Inflammatory bowel disease (IBD) patients are a high-risk population for opportunistic infections. The IBD group of the Chinese Society of Gastroenterology of the Chinese Medical Association organized an expert group to discuss and develop this consensus opinion. This consensus opinion referenced clinical study results from China and other countries to provide guidance for clinical practices. Eight major topics, including cytomegalovirus infection, Epstein-Barr virus infection, viral hepatitis, bacterial infection, Mycobacterium tuberculosis infection, fungal infection, parasitic infection, and vaccines were introduced in this article.

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Su-Ying Li, Jia Jia, Lu-Zhou Xu, Kai Zheng
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Case Report

Fatal infections in older patients with inflammatory bowel disease on anti-tumor necrosis factor therapy: Way-Seah Lee, Najib Azmi, Ruey-Terng Ng, Sik-Yong Ong, Sasheela Sri La Ponnampalavanar, Sanjiv Mahadeva, Ida Hilmi; Intest Res 2017;15(4):524-528. Published online October 23, 2017; DOI: https://doi.org/10.5217/ir.2017.15.4.524

Abstract PDF PubReader ePub

Anti-tumor necrosis factor (anti-TNF) is highly effective in inflammatory bowel disease (IBD); however, it is associated with an increased risk of infections, particularly in older adults. We reviewed 349 patients with IBD, who were observed over a 12-month period, 74 of whom had received anti-TNF therapy (71 patients were aged <60 years and 3 were aged ≥60 years). All the 3 older patients developed serious infectious complications after receiving anti-TNFs, although all of them were also on concomitant immunosuppressive therapy. One patient developed disseminated tuberculosis, another patient developed cholera diarrhea followed by nosocomial pneumonia, while the third patient developed multiple opportunistic infections (Pneumocystis pneumonia, cryptococcal septicemia and meningitis, Klebsiella septicemia). All 3 patients died within 1 year from the onset of the infection(s). We recommend that anti-TNF, especially when combined with other immunosuppressive therapy, should be used with extreme caution in older adult patients with IBD.

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Original Article

Spectrum of chronic small bowel diarrhea with malabsorption in Indian subcontinent: is the trend really changing?: Nirav Pipaliya, Meghraj Ingle, Chetan Rathi, Prateik Poddar, Nilesh Pandav, Prabha Sawant; Intest Res 2016;14(1):75-82. Published online January 26, 2016; DOI: https://doi.org/10.5217/ir.2016.14.1.75

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Background/Aims

This study aimed to document the recent etiological spectrum of chronic diarrhea with malabsorption and also to compare features that differentiate tropical sprue from parasitic infections, the two most common etiologies of malabsorption in the tropics.

Methods

We analyzed 203 consecutive patients with malabsorption. The etiological spectrum and factors that differentiated tropical sprue from parasitic infections were analyzed.

Results

The most common etiology was tropical sprue (n=98, 48.3%) followed by parasitic infections (n=25, 12.3%) and tuberculosis (n=22, 10.8%). Other causes were immunodeficiency (n=15, 7.3%; 12 with human immunodeficiency virus and 3 with hypogammaglobulinemia), celiac disease (n=11, 5.4%), Crohn's disease (n=11, 5.4%), small intestinal bacterial overgrowth (n=11, 5.4%), hyperthyroidism (n=4, 1.9%), diabetic diarrhea (n=4, 1.9%), systemic lupus erythematosus (n=3, 1.4%), metastatic carcinoid (n=1, 0.5%) and Burkitt's lymphoma (n=1, 0.5%). On multivariate analysis, features that best differentiated tropical sprue from parasitic infections were larger stool volume (P=0.009), severe weight loss (P=0.02), knuckle hyperpigmentation (P=0.008), low serum B12 levels (P=0.05), high mean corpuscular volume (P=0.003), reduced height or scalloping of the duodenal folds on endoscopy (P=0.003) and villous atrophy on histology (P=0.04). Presence of upper gastrointestinal (GI) symptoms like bloating, nausea and vomiting predicted parasitic infections (P=0.01).

Conclusions

Tropical sprue and parasitic infections still dominate the spectrum of malabsorption in India. Severe symptoms and florid malabsorption indicate tropical sprue while the presence of upper GI symptoms indicates parasitic infections.

Citations

Citations to this article as recorded by

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