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  Pseudomembranous colitis

This disease is an infection of the lower intestinal tract – the colon. It can be caused by the bacterium Clostridium difficile. Pseudomembranous colitis can be severe causing toxic megacolon and death. Toxic megacolon is a condition in which the colon becomes dangerously dilated. Pseudomembranous colitis is also referred to as antibiotic associated colitis, Colitis – pseudomembranous or necrotizing colitis.

Pseudomembranous colitis
Pseudomembranous colitis


Symptoms

Symptoms of pseudomembranous colitis are watery diarrhea, urge to have a bowel movement, bloody stools, low-grade fever and severe abdominal cramps. This disease is caused by taking antibiotics. When or if the disease progresses to a C. difficile overgrowth or infection, pus will also be present in bowel movements.

Cause

Pseudomembranous colitis is caused by antibiotics. Almost all cases diagnosed, involve patients who have recently finished a course in antibiotics. Antibiotics disrupt the natural levels of bacterial flora in the colon, causing an overgrowth of unhealthy bacteria. The ‘bad’ bacteria, C. difficile leads to infection in the colon. This bacteria releases a strong toxin that causes the mucosa of the colon to become raw, irritated and bleed.

Besides antibiotic use, patients who are elderly, undergoing chemotherapy, recent surgery or a previous diagnosis of pseudomembranous colitis are at an increased risk to get it again. Children under one year rarely get this disease, because of antibodies received from the mother during gestation. The bacteria C. difficile is rarely dangerous for young children. Older adults or recent surgery patients are at a higher risk for contracting pseudomembranous colitis.

Diagnosis

Diagnosis for pseudomembranous colitis is made by testing for the bacteria C. difficile and a colonoscopy. A colonoscopy is a procedure performed on a patient who is sedated. During this procedure a flexible scope with a camera on the tip is passed through the anus and throughout the colon. Physicians can get a clear picture of the inflammation or any other abnormalities present in the colon.

Treatment

This disease can become extremely dangerous. If the colon develops a perforation or whole, the patient is at risk for sepsis. Sepsis is a systemic infection of the blood that can lead to organ failure and death. To treat pseudomembranous colitis an oral or intravenous antibiotic is administered. Antibiotics are effective in treating pseudomembranous colitis, even though they disrupted the flora. Using a different antibiotic than the one that precipitated the disease will enable the bowel to adjust the intestinal flora. The antibiotic, metronidazole is the most commonly used antibiotic to treat pseudomembranous colitis Adjunctive therapy uses bile acid resin, which binds to C. difficile toxin to enable the effective expulsion of the harmful bacteria from the lower gastrointestinal tract. The bile acid resin used most often is cholestyramine.

Rebuilding the natural or healthy bacterial flora of the colon is important to return to normal bowel functioning. This is referred to fecal bacterio-therapy. Replacing lost fluids is extremely important. This can be administered orally via electrolyte solutions or intravenously.

If antibiotics are ineffective, patients may require a colonectomy or removal of the colon. In this procedure, the intestines are attached to a hole surgically created in the abdominal wall. A colostomy bad is used to collect human waste. All or part of the colon may need to be removed depending on the severity of the pseudomembranous colitis.

Twenty percent of infections can re-occur in patients diagnosed with pseudomembranous colitis.

Prevention

Antibiotics should be taken with food. Keeping the intestinal flora especially healthy during a course of antibiotics is useful in preventing pseudomembranous colitis. This can be achieved with dietary supplements from health food stores, yoghurt with active cultures or Kefir. Patients who have previously been diagnosed with pseudomembranous colitis should be sure to inform their physicians if they are prescribed with antibiotics.

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