New study finds vitamin D levels a predictor of resolution for symptom of C. difficile

Posted on: January 20, 2015   by  John Cannell, MD

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Pseudomembranous colitis (PS) is a relatively rare but very disabling disease caused by an infection by a bacterium, clostridium difficile. Afflicted patients have frequent bloody diarrhea, so frequent they have to wear diapers. Occasionally, part of the lining of the colon is removed and passed in the stool, known as a psuedomembrane, giving the disease its name. The incidence, recurrence, and death rates for clostridium difficile-associated diarrhea (CDAD) have increased markedly over the past 10 years despite treatment with antibiotics.

PS has hit the news lately due to the treatment of PC and CDAD with, of all things, stool transplants, also known as fecal microbiota transplantation (FMT). FMT is a process by which the feces of a healthy individual is introduced into a patient with PC or CDAD using a retention enema, orogastric tube, or capsule containing freeze dried material.

As unpleasant as it sounds, it is very effective. A randomized controlled trial in the New England Journal of Medicine proved its efficacy. In fact, the trial (using a nasal-duodenal tube to insert donor feces) had to be stopped early because the stool transplants were so effective that the ethics committee ruled that the placebo patients should immediately be given the stool transplants.

Some scientists think a wide range of diseases could be successfully treated with stool transplants. If you want to read more about it, the New Yorker recently had a great article:

Eakin E. The Excrement Experiment; treating disease with fecal transplants. New Yorker. Medical Dispatch December 1, 2014.

There is also evidence that vitamin D may be able to help CDAD patients. Last year, Dr. Wang and colleagues, of Weill Cornell Medical College in New York, reported on 62 patients hospitalized with CDAD and treated with antibiotics. At 30-day follow up, 45% of patients had died (that’s how lethal this disease is), 16% had persistent or recurrent diarrhea and in 39% of patients the CDAD had resolved. So non-resolution was seen in 61% of patients.

Two variables were found to be independent predictors of resolution of CDAD: normal vitamin D levels (p = 0.028) and age <70 years (p = 0.024). Normal vitamin D levels were defined as anything above 21 ng/ml. Subjects with low vitamin D were 4.75 times more likely to fail to resolve CDAD than subjects with normal vitamin D. Using another model, the odds of recurrence or death was 5.6 times higher in subjects with low vitamin D levels than in subjects with normal vitamin D levels.

If I had PS or CDAD, I’d be sure my vitamin D levels were around 80 ng/ml but I would run, not walk, to one of the few institutions the FDA allows to perform FMT.

Wang WJ, Gray S, Sison C, Arramraju S, John BK, Hussain SA, Kim SH, Mehta P, Rubin M. Low vitamin D level is an independent predictor of poor outcomes in Clostridium difficile-associated diarrhea. Therap Adv Gastroenterol. 2014 Jan;7(1):14-9.

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