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PTU-030 Clostridium Difficile Associated Diarrhea (CDAD) in Hospitalized Patients – does Flexible Sigmoidoscopy (FS) Alter Management?
  1. B Krishnan1,
  2. V Sehgal1,
  3. K Besherdas1
  1. 1Gastroenterology, Chasefarm Hospital, London, UK

Abstract

Introduction Clostridium difficile (CD) colitis is a major complication of antibiotic therapy. The most widely used test for diagnosing C. difficile colitis is a test that detects toxins produced by CD in a stool sample. Flexible sigmoidoscopy (FS) or colonoscopy can show the characteristic pseudomembrane plaque appearance in about half of affected patients. It is usually performed if rapid diagnosis is needed or in a patient who has ileus. However, some patients with CD colitis will have pseudomembranes only in the right colon. Our aim was to assess whether patients, with confirmed CDAD, had their management altered following FS.

Methods A single centre, retrospective analysis of patients who had a FS with stool culture confirmed CDAD admitted to our CD ward (CDW) over 7 years (March 2005–2012) was performed at a district general hospital in North London. The medical notes, endoscopy database and electronic results of patients on CDW undergoing FS was scrutinised.

Results 18 patients on CDW had a FS during the study period. 2 patients were excluded as they were found to be CD negative. 16 of the 1535 (1.04%) patients diagnosed with CDAD at our hospital during this period had a FS. The mean age was 74.1 (range 37–93) with 6 males. FS was requested 27 days (range 1 – 100) and the procedure was performed 40 days (range 10–110) after the diagnosis of CD was made. The indications were persistent diarrhoea in 82% (13/16), bleeding PR 6% (1/16), abnormal CT scan 6% (1/16) and previous CMV colitis 6% (1/16). 8(50%) patients had a normal FS, 2(13%) had pseudomembranous colitis, and 1 (6%) patient each had adenocarcinoma, colonic polyps, diverticulosis and infective colitis. 2 (13%) patients were newly diagnosed to have ulcerative colitis and were started on mesalazine and steroids along with CD treatment.

Conclusion In this study only a small proportion of patients (1.04%) with CDAD underwent FS. However, when FS is performed in patients with CDAD with persistent symptoms it aids in clarification of the diagnosis with an abnormal FS noted in 50% of patients. From our observation we would recommend FS in CDAD if symptoms persist despite treatment due to the high positive findings at FS.

Disclosure of Interest None Declared

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