Summary
Clostridium difficile colitis may be diagnosed either by endoscopy or by laboratory tests. To determine the role of endoscopy, we reviewed 59 cases of confirmed C. difficile colitis. In all patients, the etiology was confirmed by stool tests. Twenty-nine underwent lower gastrointestinal endoscopy. In 16 (55%) there was endoscopic confirmation of pseudomembranes while 4 (14%) had only nonspecific colitis. There was no apparent difference in the rate of detection of pseudomembranes between rigid sigmoidoscopy (57%), flexible sigmoidoscopy (50%), and colonoscopy (50%). Vancomycin and metronidazole were equally effective therapy but treatment with vancomycin cost more than 250 times that for metronidazole. There were no patients in whom the diagnosis was made by endoscopy alone. Endoscopy was costly and insensitive, while noninvasive stool tests were cheap and accurate. We conclude that endoscopy should be relegated to a secondary role in the workup of antibiotic-associated diarrhea.
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References
Amin NM (1985) Antibiotic-associated pseudomembranous colitis. Am Fam Physician 31: 115–120
Bartlett JG (1985) Treatment of Clostridium difficile colitis. Gastroenterology 89: 1192–1195
Bartlett JG, Chang TW, Gurwith M, Gorbach SL, Onderdonk AB (1978) Antibiotic-associated pseudomembranous colitis due to toxin producing clostridia. N Engl J Med 298: 531–534
Bartlett JG, Tedesco FJ, Shull S, Lowe B, Chang T (1980) Symptomatic relapse after oral vancomycin therapy of antibiotic-associated pseudomembranous colitis. Gastroenterology 79: 431–434
Block BS, Lane JM, Mahmoud AI, Atef HM (1985) Clostridium difficile-associated diarrhea follows perioperative prophylaxis with cefoxitin. Am J Obstet Gynecol 153: 835–838
Bowman RA, Arrow SA, Riley TV (1986) Latex particle agglutination for detecting and identifying Clostridium difficile. J Clin Pathol 39: 212–214
Church JM, Fuzio VW (1985) The significance of quantitative results of C. difficile cultures and toxin assays in patients with diarrhea. Dis Colon Rectum 28: 765–769
Clostridium difficile test package insert. Marion Scientific, a Division of Marion Laboratories, Inc, Kansas City, Mo
Finegold SM, Dowell VR Jr (1987) Clostridium difficile-associated colitis, a monograph. Marion Laboratories, Kansas City, Mo
Gebhard RL, Gerding DN, Olson MM, Peterson LR, McClain CJ, Ansel HJ, Shaw MJ, Schwartz ML (1985) Clinical and endoscopic findings in patients early in the course of Clostridium difficile-associated pseudomembranous colitis. Am J Med 78: 45–48
George WL, Sutter VL, Citron D, Finegold SM (1979) Selective and differential medium for isolation of C. difficile. J Clin Microbiol 9: 217–219
Gross MH (1985) Management of antibiotic-associated pseudomembranous colitis. Clin Pharm 4: 304–310
Hall IC, O'Toole E (1935) Intestinal flora in new-born infants with a description of a new pathogenic anaerobe, Bacillus difficilis. Am J Dis Child 48: 390–402
Kelly MT, Champagne SG, Sherlock CH, Noble MA, Freeman HJ, Smith JA (1987) Commercial latex agglutination test for detection of Clostridium difficile-associated diarrhea. J Clin Microbiol 25: 1244–1247
Lashner BA, Todorczuk J, Sahm DF, Hanauer SB (1986) Clostridium difficile culture-positive toxin-negative diarrhea. Am J Gastroenterol 81: 940–943
Talbot RW, Walker RC, Beart RW Jr (1986) Changing epidemiology, diagnosis, and treatment of Clostridium difficile toxin-associated colitis. Br J Surg 73: 457–460
Teasley DG, Gerding DN, Olson MM (1983) Prospective randomized trial of metronidazole versus vancomycin for Clostridium-difficile-associated diarrhoea and colitis. Lancet II: 1043–1046
Tedesco FJ (1979) Antibiotic associated pseudomembranous colitis with negative proctosigmoidoscopy examination. Gastroenterology 77: 295–297
Tedesco FJ, Barton RW, Alpers DH (1974) Clindamycin associated colitis: a prospective study. Ann Intern Med 81: 429–433
Wu TC, Gersch SM (1986) Evaluation of a commercial kit for the routine detection of Clostridium difficile cytotoxin by tissue culture. J Clin Microbiol 23: 792–793
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Bergstein, J.M., Kramer, A., Wittman, D.H. et al. Pseudomembranous colitis: how useful is endoscopy?. Surg Endosc 4, 217–219 (1990). https://doi.org/10.1007/BF00316796
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DOI: https://doi.org/10.1007/BF00316796