Pseudomembranous colitis
From Wikipedia, the free encyclopedia
| ICD-10 | A04.7 |
|---|---|
| ICD-9 | 008.45 |
| DiseasesDB | 2820 |
| MedlinePlus | 000259 |
| eMedicine | med/1942 |
Pseudomembranous colitis is an infection of the colon often, but not always, caused by the bacterium Clostridium difficile. The illness is characterized by offensive-smelling diarrhea, fever, and abdominal pain. It can be severe, causing toxic megacolon, and even fatal.
Contents |
[edit] Risk factors and epidemiology
In most cases a patient presenting with pseudomembranous colitis has recently been on antibiotics. Antibiotics disturb the normal bowel bacterial flora. Clindamycin is the antibiotic classically associated with this disorder, but any antibiotic can cause the condition. Diabetics and the elderly are also at increased risk, although half of cases are not associated with risk factors.
Other risk factor include increasing age and recent major surgery. There is some evidence that proton-pump inhibitors are a risk factor for pseudomembranous colitis,<ref>Dial S, Delaney C, Schneider V, Suissa S. (2006). "Proton pump inhibitor use and risk of community-acquired Clostridium difficile-associated disease defined by prescription for oral vancomycin therapy". CMAJ 175 (7): 745–48. DOI:10.1503/cmaj.060284.</ref> but others question whether this is a false association or statistical artefact (increased PPI use is itself a marker of increased age and co-morbid illness).<ref>Pépin J, Saheb N, Coulombe M, et al. (2005). "Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile associated diarrhea: a cohort study during an epidemic in Quebec". Clin Infect Dis 41: 1254–60. PMID 16206099.</ref>
[edit] Treatment
The disease is usually treated with metronidazole (400 mg every 8 hourly). Oral vancomycin (125 mg every 6 hourly) is an alternative. Occasionally metronidazole has been associated with the development of pseudomembranous colitis. In these cases metronidazole is still effective treatment, since the cause of the colitis is not the antibiotic, but rather the change in bacterial flora from a previous round of antibiotics.
Adjunctive therapy can include cholestyramine, a bile acid resin that can be used to bind C. difficile toxin and Saccharomyces boulardii, a yeast that has shown in one study to provide benefit in pseudomembranous colitis [1].
Fecal bacteriotherapy, a procedure related to probiotic research, has been suggested as a potential cure for the disease. It involves infusion of bacterial flora acquired from the feces of a healthy donor in an attempt to restore bacterial imbalance responsible for the recurring nature of the infection.
If antibiotics do not control the infection the patient may require a colectomy (removal of the colon) for treatment of the colitis.
[edit] External links
[edit] Footnotes
<references/>
de:Antibiotikaassoziierte Kolitisfr:Colite pseudo-membraneuse nl:Pseudomembraneuze colitis pl:Rzekomobłoniaste zapalenie jelit
