Post-Infectious Irritable Bowel Syndrome with Functional Diarrhea Following C. difficile Infections: Case Studies of Responses Using Serum-Derived Bovine Immunoglobulin

Abstract

Introduction: Post-infectious irritable bowel syndrome with diarrhea (PI-IBS-D) may occur after any number of enteric infections. Because these patients tend to experience chronic loose and frequent stools, serum-derived bovine immunoglobulin/protein isolate (SBI) was considered for the management of two patients with IBS-D following recurrent Clostridium difficile infections (CDI). Furthermore, C. difficile toxin binding has been described in an animal model which added to the consideration for its use in two challenging cases. SBI is a prescription medical food intended for the management of chronic loose and frequent stools in patients with IBS-D, inflammatory bowel disease (IBD) and HIV-associated enteropathy. Case Presentations: Both patients were treated for relapsing CDI and eventually cleared. Despite negative retesting for C. difficile, a 39-year old Caucasian female patient developed persistent diarrhea in the setting of intolerance to common therapies. The severity of her condition led her to file for disability. Within two weeks of starting SBI 5 g QID, her frequent loose stools were completely managed but returned upon discontinuation. SBI was restarted resulting again in complete management of frequent loose stools. She now continues on SBI 5g QD and has returned back to work. The second patient, a 57-year old Caucasian female, experienced ongoing diarrhea with alternating bouts of constipation after clearance of her recurrent CDI. Upon use of SBI 5g BID, she noticed better management within a few days. Therapy was reduced to SBI 5g QD to avoid possible constipation and she reports regulation of her bowel habits. Discussion: These cases highlight specific symptoms that result from C. difficile-associated PI-IBS, the management that SBI can provide when considered an option for therapy, and the impact disease manifestations can have on quality of life. These cases further suggest the need for additional study of this nutritional agent in post-C. difficile infectious IBS patients.