Clostridium Difficile Colitis - Diagnosis, Treatment

Definition	Symptoms	Causes	Diagnosis	Complications
Treatment	Risk factors	Prevention	Prognosis	Images

How is Clostridium Difficile Colitis diagnosed?

Tests and procedures used to diagnose pseudomembranous colitis and to search for complications include:

History

A history of antibiotic use is important in the diagnosis of C. difficile colitis. Patients taking antibiotics (or recently having taken antibiotics) who develop abdominal pain, cramps and diarrhea are usually tested for C. difficile infection. However, doctors do not always wait for the appearance of diarrhea to start testing for C. difficile since in rare instances C. difficile can cause abdominal pain and tenderness without diarrhea.

Laboratory tests

Patients with C. difficile colitis often have elevated white blood cell counts in the blood, and, in severe colitis, the white blood cell counts can be very high (20,000 to 40,000). Patients with C. difficile colitis also often have white blood cells in their stool when a sample of stool is examined under a microscope. Elevated white blood cell counts and white blood cells in the stool, however, only demonstrate that there is colitis and not that the cause of the colitis is C. difficile. More specific tests are necessary to determine whether C. difficile is the cause of the colitis.

The most widely used test for diagnosing C. difficile colitis is a test that detects toxins produced by C. difficile in a sample of stool. There are two different toxins, toxin A and toxin B, both capable of causing colitis. Accurate tests for both toxins are available commercially for use in all laboratories.

Colonoscopy or sigmoidoscopy.

In both of these tests, your doctor uses a tube with a miniature camera at its tip to examine the inside of your colon for signs of pseudomembranous colitis — raised, yellow plaques (lesions), as well as swelling.

Imaging tests.

 If you have severe symptoms, your doctor may obtain an abdominal X-ray or an abdominal CT scan to look for complications such as toxic megacolon or colon rupture.

How is Clostridium Difficile Colitis treated?

The decision to treat C. difficile infection and on the type of treatment depends on the severity of the illness. No treatment is needed if you have no symptoms but are known to carry the germs (bacteria) in your gut. However, if symptoms develop, some of the treatments below may be needed. If you are not already in hospital, people who have mild infection can often be treated at home. However, if the infection is more severe, you will usually be admitted to hospital so that you can be treated and closely monitored.

Treatment strategies include:

Stopping the antibiotic or other medication that's thought to be causing your signs and symptoms, if possible. Sometimes, this may be enough to resolve your condition or at least ease signs, such as diarrhea.

Starting an antibiotic likely to be effective against C. difficile. If you still experience signs and symptoms, your doctor may use a different antibiotic to treat C. difficile. This allows the normal bacteria to grow back, restoring the healthy balance of bacteria in your colon. You may be given antibiotics by mouth, through a vein or through a tube inserted through the nose into the stomach (nasogastric tube). Depending on your condition, doctors will use most often use metronidazole (Flagyl), vancomycin, fidaxomicin (Dificid) or a combination.

Having fecal microbial transplantation (FMT). If your condition is extremely severe, you may be given a transplant of stool (fecal transplant) from a healthy donor to restore the balance of bacteria in your colon. The donor stool may be delivered through a nasogastric tube, inserted into the colon or placed in a capsule you swallow. Often, doctors will use a combination of antibiotic treatment followed by FMT.

Treating recurring Clostridium Difficile Colitis

Approximately 10% to 20% of successfully treated patients can experience a relapse of C. difficile colitis with recurrence of diarrhea, abdominal cramps, and abdominal pain. Relapses typically occur days or even weeks after treatment is stopped. Some patients may experience several relapses.

Treatment options may include:

Repeat antibiotics.

You may need a second or third round of antibiotics to resolve your condition.

Surgery.

 Surgery may be an option in people who have progressive organ failure, rupture of the colon and inflammation of the lining of the abdominal wall (peritonitis). Surgery has typically involved removing all or part of the colon (total or subtotal colectomy). A newer surgery that involves laparoscopically creating a loop of colon and cleaning it (diverting loop ileostomy and colonic lavage) is less invasive and has had positive results.

Fecal microbial transplantation (FMT).

FMT is used to treat recurrent pseudomembranous colitis. You'll receive healthy, cleaned stool in a capsule, nasogastrically or inserted into your colon.