Pseudomembranous enterocolitis: Difference between revisions

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In [[gastroenterology]], '''pseudomembranous enterocolitis''' is an "acute inflammation of the intestinal mucosa that is characterized by the presence of pseudomembranes or plaques in the small intestine (pseudomembranous enteritis) and the large intestine (pseudomembranous colitis). It is commonly associated with [[antibiotic]] therapy and [[clostridium difficile]] colonization."<ref>{{MeSH}}</ref> The disorder is an increasing matter of concern, as it is one of the more common [[nosocomial]] infections, but is also being seen in community-acquired cases.


In [[medicine]], '''pseudomembranous enterocolitis''' is an "acute inflammation of the intestinal mucosa that is characterized by the presence of pseudomembranes or plaques in the small intestine (pseudomembranous enteritis) and the large intestine (pseudomembranous colitis). It is commonly associated with [[antibiotic]] therapy and [[clostridium difficile]] colonization."<ref>{{MeSH}}</ref>
==Epidemiology==
About 50% of patients with diarrhea after [[antibiotic]]s that is severe enough to be admitted to the hospital have pseudomembranes on [[colonoscopy]].<ref name="pmid17028914">{{cite journal |author=Lee KS, Shin WG, Jang MK, ''et al'' |title=Who are susceptible to pseudomembranous colitis among patients with presumed antibiotic-associated diarrhea? |journal=Dis. Colon Rectum |volume=49 |issue=10 |pages=1552–8 |year=2006 |month=October |pmid=17028914 |doi=10.1007/s10350-006-0694-z |url=http://dx.doi.org/10.1007/s10350-006-0694-z |issn=}}</ref>


==Treatment==
==Diagnosis==
===Antibiotics===
[[Clinical practice guideline]]s address diagnosis.<ref name="pmid20307191">{{cite journal| author=Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC et al.| title=Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). | journal=Infect Control Hosp Epidemiol | year= 2010 | volume= 31 | issue= 5 | pages= 431-55 | pmid=20307191
Various antibiotics have been studied.<ref name="pmid17636768">{{cite journal |author=Nelson R |title=Antibiotic treatment for Clostridium difficile-associated diarrhea in adults |journal=Cochrane Database Syst Rev |volume= |issue=3 |pages=CD004610 |year=2007 |pmid=17636768 |doi=10.1002/14651858.CD004610.pub3 |url=http://dx.doi.org/10.1002/14651858.CD004610.pub3 |issn=}}</ref><ref name="pmid8722937">{{cite journal |author=Wenisch C, Parschalk B, Hasenhündl M, Hirschl AM, Graninger W |title=Comparison of vancomycin, teicoplanin, metronidazole, and fusidic acid for the treatment of Clostridium difficile-associated diarrhea |journal=Clin. Infect. Dis. |volume=22 |issue=5 |pages=813–8 |year=1996 |month=May |pmid=8722937 |doi= |url= |issn=}}</ref><ref name="pmid12135033">{{cite journal |author=McFarland LV, Elmer GW, Surawicz CM |title=Breaking the cycle: treatment strategies for 163 cases of recurrent Clostridium difficile disease |journal=Am. J. Gastroenterol. |volume=97 |issue=7 |pages=1769–75 |year=2002 |month=July |pmid=12135033 |doi=10.1016/S0002-9270(02)04195-3 |url= |issn=}}</ref>
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&retmode=ref&cmd=prlinks&id=20307191 | doi=10.1086/651706 }} </ref>


===Administration of bacteria===
Sigmoidoscopy has a [[sensitivity and specificity|sensitivity]] of 31% in detecting pseudomembranes as compared to [[colonosopy]].<ref name="pmid7323683">Seppala, K, Hjelt, L, Supponen, P. Colonoscopy in the diagnosis of antibiotic-associated colitis. Scand J Gastroenterol 1981; 16:465. PMID 7323683</ref>
[[Priobiotic]] administration may<ref name="pmid16635227">{{cite journal |author=McFarland LV |title=Meta-analysis of probiotics for the prevention of antibiotic associated diarrhea and the treatment of Clostridium difficile disease |journal=Am. J. Gastroenterol. |volume=101 |issue=4 |pages=812–22 |year=2006 |month=April |pmid=16635227 |doi=10.1111/j.1572-0241.2006.00465.x |url=http://dx.doi.org/10.1111/j.1572-0241.2006.00465.x |issn=}}</ref> or may not <ref name="pmid18254055">{{cite journal |author=Pillai A, Nelson R |title=Probiotics for treatment of Clostridium difficile-associated colitis in adults |journal=Cochrane Database Syst Rev |volume= |issue=1 |pages=CD004611 |year=2008 |pmid=18254055 |doi=10.1002/14651858.CD004611.pub2 |url=http://dx.doi.org/10.1002/14651858.CD004611.pub2 |issn=}}</ref>help according to a [[meta-analysis|meta-analyses]] and a more recent [[randomized controlled trial]].<ref name="pmid18840110">{{cite journal |author=Klarin B, Wullt M, Palmquist I, Molin G, Larsson A, Jeppsson B |title=Lactobacillus plantarum 299v reduces colonisation of Clostridium difficile in critically ill patients treated with antibiotics |journal=Acta Anaesthesiol Scand |volume=52 |issue=8 |pages=1096–102 |year=2008 |month=September |pmid=18840110 |doi=10.1111/j.1399-6576.2008.01748.x |url=http://dx.doi.org/10.1111/j.1399-6576.2008.01748.x |issn=}}</ref>


Rectal infusion of feces helped in a case report.<ref name="pmid6137662">{{cite journal |author=Schwan A, Sjölin S, Trottestam U, Aronsson B |title=Relapsing clostridium difficile enterocolitis cured by rectal infusion of homologous faeces |journal=Lancet |volume=2 |issue=8354 |pages=845 |year=1983 |month=October |pmid=6137662 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(83)90753-5 |issn=}}</ref>
==Treatment==
{{Seealso|Clostridium difficile}}


==References==
==References==
<references/>
<references/>

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Pseudomembranous enterocolitis
Img1.jpg

Pseudomembranous enterocolitis
MeSH D004761

In gastroenterology, pseudomembranous enterocolitis is an "acute inflammation of the intestinal mucosa that is characterized by the presence of pseudomembranes or plaques in the small intestine (pseudomembranous enteritis) and the large intestine (pseudomembranous colitis). It is commonly associated with antibiotic therapy and clostridium difficile colonization."[1] The disorder is an increasing matter of concern, as it is one of the more common nosocomial infections, but is also being seen in community-acquired cases.

Epidemiology

About 50% of patients with diarrhea after antibiotics that is severe enough to be admitted to the hospital have pseudomembranes on colonoscopy.[2]

Diagnosis

Clinical practice guidelines address diagnosis.[3]

Sigmoidoscopy has a sensitivity of 31% in detecting pseudomembranes as compared to colonosopy.[4]

Treatment

See also: Clostridium difficile

References

  1. ↑ Anonymous (2024), Pseudomembranous enterocolitis (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. ↑ Lee KS, Shin WG, Jang MK, et al (October 2006). "Who are susceptible to pseudomembranous colitis among patients with presumed antibiotic-associated diarrhea?". Dis. Colon Rectum 49 (10): 1552–8. DOI:10.1007/s10350-006-0694-z. PMID 17028914. Research Blogging.
  3. ↑ Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC et al. (2010). "Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA).". Infect Control Hosp Epidemiol 31 (5): 431-55. DOI:10.1086/651706. PMID 20307191. Research Blogging.
  4. ↑ Seppala, K, Hjelt, L, Supponen, P. Colonoscopy in the diagnosis of antibiotic-associated colitis. Scand J Gastroenterol 1981; 16:465. PMID 7323683
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