Medline ® Abstracts for References 91,95
of 'Clostridium difficile infection in adults: Clinical manifestations and diagnosis'
Antibiotic associated pseudomembranous colitis with negative proctosigmoidoscopy examination.
Most investigators have stressed that the diagnosis of antibiotic associated pseudomembranous colitis is made by proctosigmoidoscopic examination. In our investigation, 6 patients with tissue culture evidence of a clostridial toxin in stools and either normal or only edematous rectal mucosa were studied with total colonoscopy. Five of six patients demonstrated pseudomembranes located in various areas of the colon at a time when the rectosigmoid area was uninvolved. This demonstrates the occurrence of antibiotic associated pseudomembranous colitis which can be missed by routine proctosigmoidoscopy. The incidence of rectal sparing in this disease remains undetermined. Further investigation to determine the occurrence of antibiotic colitis, response to different treatments, or sensitivity of tissue culture assays as a diagnostic aid in antibiotic associated pseudomembranous colitis must take this subgroup into account.
Colonoscopy in the diagnosis of antibiotic-associated colitis. A prospective study.
SeppäläK, Hjelt L, Sipponen P
Scand J Gastroenterol. 1981;16(4):465.
Colonoscopic findings among 16 patients with histologically proved antibiotic-associated pseudomembranous colitis (PMC) were analyzed. The characteristic endoscopic changes of PMC with pseudomembranes were observed in only 5 (31%) out of 16 patients by sigmoidoscopy but in 11 (85%) out of 13 patients in whom colonoscopy was also performed. The findings suggest the importance of colonoscopy in the early diagnosis of PMC and indicate that the typical endoscopic changes of PMC are limited to the colon above the rectosigmoid area in most patients with antibiotic-associated colitis. It is emphasized that colonoscopy should be performed at least in clinically suspected PMC cases, in which the early diagnosis of PMC might be missed if sigmoidoscopy alone is performed.