伪膜性肠炎的临床特点及内镜分析

目的探讨伪膜性肠炎(pseudomembranous colitis,PMC)的诱因、临床特点、结肠镜下特征、诊断及防治。方法对福建医科大学附属漳州市医院2011年1月-2015年6月收治住院的43例PMC患者进行回顾性分析。结果所有患者均出现腹泻,轻-中度患者25例、重度患者14例、复杂型4例。重度患者多为腹部及盆腔术后、肿瘤、糖尿病及高龄患者,结肠镜检查表现分类与疾病严重程度相符。所有患者停用抗生素及激素类药物,口服甲硝唑或万古霉素后,均获得治愈或好转。结论 PMC常在伴有基础疾病或高龄患者应用抗生素后出现,结肠镜检查有助于诊断、判断疾病严重程度及随访观察。     

内镜诊断伪膜性肠炎8例报告

目的　探讨伪膜性肠炎 (PMC)的临床表现及内镜特征。方法　对 8例PMC进行回顾性分析。结果　全部患者均在使用广谱抗生素过程中出现腹泻、腹痛、血便等表现。接受结肠镜检 ,提示为PMC ,其中 4例患者粪便中培养出难辨梭状芽胞杆菌。结论　PMC多在应用抗生素后发病。老年人、重病患者及外科大手术后患者为易感人群。结肠镜检查是诊断PMC快速而可靠的方法之一     

伪膜性肠炎诊治21例

[目的]对抗生素所致伪膜性肠炎（PMC）进行分析,总结临床经验教训,提高诊治水平。[方法]收集2001年1月-2007年6月经结肠镜检查确诊的PMC 21例相关资料,进行回顾性总结和分析。[结果]全部患者在使用广谱抗生素过程中或之后出现腹泻、腹痛等症状。结肠镜下见水肿黏膜上附有伪膜。21例PMC患者经治疗,有效20例,1例重度患者死亡。[结论]抗生素使用不合理是PMC的主要原因,结肠镜和病理活检是诊断PMC的主要方法。对应用抗生素期间或之后出现严重的腹泻、腹痛者应尽早行结肠镜检查。     

中老年假膜性肠炎患者17例临床特征分析

目的分析中老年患者假膜性肠炎（PMC）的临床特征,提高临床对PMC的认识及诊治水平。方法回顾性分析合肥市第一人民医院2008年5月至2012年3月收治的17例PMC患者的临床资料。结果17例PMC住院患者平均年龄65岁,均存在基础疾病。患者均在使用抗生素过程中出现腹泻并伴有不同程度的腹痛等症状,其中4例合并腹水。15例联合使用两种及以上抗生素。肠镜多有典型的假膜样改变。经停用抗生素,使用甲硝唑、益生菌等治疗,14例好转出院。结论应重视存在免疫力低下原发病的中老年患者使用抗生素时PMC的诊断;除腹泻、腹痛等症状外,腹水可能是PMC的临床特征之一;粪便涂片联合结肠镜检查有益PMC的诊断;及时停用抗生素,联合甲硝唑或万古霉素及益生菌是治疗PMC的主要方法。     

伪膜性肠炎的内镜与临床特征研究

目的 通过对抗生素所致伪膜性肠炎(pseudrmembranous colitis,PMC)的内镜下诊断分析,总结其内镜下特征,提高诊治水平.方法 对我院近3年来内科诊治的17例PMC进行回顾性分析.结果 PMC多发于合并有长期慢性疾病、年龄大、体质差及抗生素应用不规范的老年患者,17例病人中,14例系老年重症患者.全部患者均在使用广谱抗生素过程出现腹泻、腹痛、血便等症状.均接受结肠镜检查,提示为PMC.结论 结肠镜检杳是诊断PMC快速而可靠的方法.重视对内科老年人及重症病患者,对长期大量使用抗生素的老年患者出现腹痛、腹泻时,结合结肠镜的特征表现首先应考虑有无PMC,及早停用抗生素,使用足量和足疗程的甲硝唑和万古霉素和相应的微生态制剂是治疗PMC有效方法.     

16例伪膜性肠炎临床分析

目的总结伪膜性肠炎的临床表现，分析讨论影响其治疗与预后的因素。方法回顾分析16例伪膜性肠炎患者的用药及临床资料。结果16例伪膜性肠炎患者中绝大部分患者有在使用广谱抗生素过程中出现腹泻、腹痛等表现，少部分在使用大量激素后出现腹泻、腹痛等表现，其发生与使用第三代头孢菌素和喹诺酮类关系最为密切。结论伪膜性肠炎多在应用抗生素或激素过程中发病，老年人、重症患者及外科大手术患者为易感人群。根据使用抗生素或激素的病史、临床表现及结肠镜下典型表现可做出临床诊断。     

伪膜性肠炎32例临床分析

目的 通过对抗生素所致的伪膜性肠炎(pseudomembranous colitis, PMC)的分析,总结临床经验教训,提高临床对伪膜性肠炎警惕及诊治水平.方法 收集本院2005年12月～2008年10月32例经肠镜诊断的PMC住院患者资料,从年龄、合并疾病、抗生素使用种类、临床表现及诊断、治疗方法 等方面进行回顾性总结与分析.结果 32例PMC住院患者平均年龄为62岁,27例患者存在基础疾病.所有患者在使用抗生素过程中出现腹泻并伴有不同程度的其他症状.以头孢类抗生素使用最多,有29例患者联合使用两种或两种以上抗生素.肠镜多有典型的伪膜样病灶.经停用抗生素,使用甲硝唑、万古霉素、益生菌等治疗后,28例好转出院.结论 抗生素应用不合理是引起PMC的主要原因.对长期大量使用抗生素的患者出现腹痛、腹泻时,应警惕有无PMC,及时停用抗生素,足量、足疗程使用甲硝唑和万古霉素是PMC的有效治疗方法 .     

伪膜性肠炎45例临床诊治分析

目的通过对伪膜性肠炎(PMC)患者临床特点进行回顾性分析,总结经验及教训,提高诊治水平。方法对该院2005~2015年确诊为PMC的45例住院患者一般资料、临床表现、实验室及内镜检查、治疗方法、预后等进行回顾性总结及分析。结果 PMC易发于住院期间应用广谱抗生素的老年患者,尤其是手术后、应用质子泵抑制剂、免疫抑制剂患者。结论抗生素应用不规范是引发PMC的主要原因。对长期使用广谱抗生素的老年患者出现常规方法难控性腹泻时应考虑本病可能,结肠镜检查是快速、安全及特异性高诊断方法。甲硝唑是治疗老年PMC患者有效药物。     

22例伪膜性结肠炎临床特征分析

背景:我国不合理使用抗生素的现象严重,抗生素相关性腹泻如伪膜性结肠炎(PMC)的发病率呈上升趋势。目的:综合分析PMC的临床特征以提高其诊治水平。方法:收集2007年6月～2012年2月于湖南省人民医院住院治疗,经结肠镜检查确诊的PMC患者,对其病史资料进行回顾性分析。结果:共22例PMC患者纳入研究,其中70岁以上者18例(81.8%),18例患者存在基础疾病。所有患者均于使用抗生素过程中出现腹泻,并可伴有不同程度的腹痛、发热、血便等其他症状。使用头孢菌素类抗生素者最多见(14例),20例患者联合使用两种或两种以上抗生素。21例接受结肠镜检查者均可见典型伪膜样病灶,内镜分型轻度9例,中度7例,重度5例。经停用原有抗生素以及使用甲硝唑、万古霉素、益生菌制剂等治疗后,21例患者好转出院。结论:PMC多发生于有基础疾病的老年人,病程早期缺乏特异性临床表现。结肠镜检查是诊断PMC的重要手段之一,确诊后应尽早停用原有抗生素,使用足量、足疗程的甲硝唑和万古霉素以及益生菌制剂。     

伪膜性肠炎15例诊治分析

目的分析因使用抗生素所致的伪膜性肠炎（PMC）的诊断及治疗,提高对PMC的认识及诊治水平。方法对15例PMC患者的临床资料进行回顾性分析。结果15例患者中,年龄〉60岁者12例;使用2种以上抗生素15例;合并器官功能不全的重症患者6例（40％）;手术患者1例（6．7％）。临床表现：15例患者均在使用广谱抗生素后出现腹泻、腹痛,腹泻均为水样性,腹痛位于脐周或中下腹部,为隐痛;体温37．5℃-39．2℃。实验室检查：患者白细胞数均升高;常规粪便革兰氏染色可见多量阳性粗大杆菌;连续直接涂片查粪杆／球茵比例明显失调。经停用抗生素、补充益生茵调整肠道茵群、蒙脱石散（思密达）止泻、口服甲硝唑等综合治疗,15例患者均痊愈。结论在基层医院,大便涂片革兰氏染色找阳性粗大杆菌及肠镜等检查综合分析是诊断PMC的可靠方法。确诊后患者须停用抗生素,积极进行补充益生菌调整肠道茵群、口服甲硝唑等综合治疗。合理使用抗生素,可降低抗生素相关性肠炎,降低PMC的发生率。     

抗结核药物导致伪膜性肠炎一例并文献复习

目的 探讨抗结核药物引起伪膜性肠炎的机制、临床特征,为临床诊疗提供参考.方法 报道并分析菏泽市立医院收治的1例伪膜性肠炎患者的临床资料,并收集1990年1月至2020年5月国内外报道的抗结核药物导致伪膜性肠炎的文献,分析导致伪膜性肠炎的药物及疾病临床特点、预后情况并进行总结.结果 联同本例共复习抗结核药物导致伪膜性肠炎...     

Clinical aspects of rifampicin-associated pseudomembranous colitis

Pseudomembranous colitis (PMC) is known to develop after antibiotic administration, but antituberculosis agents are rarely associated with this disorder. We report 6 cases of PMC after rifampicin administration; the clinical manifestations, laboratory findings, imaging findings, and clinical course are described. The median age of patients was 68 years (range, 54 to 82 y). All patients were diagnosed with active pulmonary tuberculosis by sputum smear and culture, and 2 suffered from type 2 diabetes mellitus. The average interval between initiation of antituberculosis therapy and the onset of diarrhea was 19.8 days. The anatomic distribution of PMC included the rectum and sigmoid colon in 5 cases and up to the hepatic flexure in 1 case. All patients were cured with medical treatment, which include discontinuation of rifampicin and oral metronidazole and vancomycin. PMC recurred in 1 patient after retreatment with rifampicin. Our findings suggest that patients who are treated with antituberculosis agents, who develop acute diarrhea during or after therapy, should be evaluated for PMC.     

Pseudomembranous colitis presenting as acute colonic obstruction without diarrhea in a patient with gastric Burkitt lymphoma

Pseudomembranous colitis (PMC) usually manifests as fever and diarrhea in hospitalized patients treated with systemic antibiotics. We described a case of PMC with intestinal obstruction but without diarrhea. A 60-year-old man was hospitalized for chemotherapy for the treatment of Burkitt lymphoma of the stomach. The patient became febrile and complained of crampy abdominal pain during the post-chemotherapy nadir. Plain abdominal radiography showed some intestinal gas and niveau. Because stool cytotoxin assay for clostridium difficile was positive and colon fiberscopic examination showed a pseudomembrane at the left side of the colon, and a diagnosis of PMC was made. Treatment with intracolonic vancomycin administration by colonoscopy and nasoileus tube was successful. Physicians should take into account the possibility of bowel obstruction due to PMC occurring in patients undergoing chemotherapy and perform emergency colonoscopy examination of suspected cases.     

PSEUDOMEMBRANOUS COLITIS COMPLICATING ULCERATIVE COLITIS

Clostridium difficile toxin (CD toxin) causes antibiotic‐associated colitis, or pseudomembranous colitis (PMC). Although CD toxin is sometimes found in the stools of patients with ulcerative colitis (UC), UC is rarely complicated by PMC. We report herein a case of PMC complicating UC, and present a review of the literature. A 71‐year‐old woman was diagnosed as having UC of the left colon, and treated with prednisolone and mesalazine. Later, however, lumbar spinal stenosis was also detected. After surgery for lumbar spinal stenosis, she suffered postoperative infection of the lumbar region. After 3‐week treatment with antibiotics, she developed diarrhea, bloody stools, and abdominal pain. Colonoscopy revealed PMC of the cecum, ascending colon, sigmoid colon, and rectum. Stools were positive for CD toxin. As cefotiam hydrochloride, levofloxacin hydrate (LVFX), and prednisolone were suspected as the causative agents, she was treated with 1.5 g vancomycin (VCM) daily for 2 weeks without ceasing LVFX. Her symptoms improved, and colonoscopy confirmed resolution of PMC. The possibility of PMC should be considered in UC patients treated with antibiotics, immunosuppressive agents or corticosteroids who complain of gastrointestinal symptoms. These patients should be thoroughly investigated by several modalities, including colonoscopy and CD toxin testing.     

胃肠癌术后伪膜性肠炎回顾分析

目的研究我院胃肠癌术后发生伪膜性肠炎的临床特点。 方法分析我科2010年1月至2012年12月收治的236例胃癌、结肠癌以及直肠癌术后发生伪膜性肠炎患者的临床资料。 结果236例患者所患疾病：胃癌61例,结肠癌98例,直肠癌77例。患者年龄范围35～78岁,平均年龄64.5岁。其中201例患者于术后6天内发生伪膜性肠炎。236例患者均常规予以鼻饲甲硝唑,肠道益生菌治疗,其中61例患者加用口服万古霉素治疗。233例患者治愈康复,3例死亡。 结论高龄、抗菌药物应用种类多、时间长以及术后胃酸分泌减少是术后伪膜性肠炎的高危因素。合理应用抗生素、注意早期肠内营养的应用,减少伪膜性肠炎的发生。另外,早期诊断、早期治疗以及隔离治疗对伪膜性肠炎患者是十分必要的。     

Colonoscopy and SeHCAT for investigation of chronic diarrhea

BACKGROUND/AIMS: Chronic diarrhea is a common problem. Colonoscopy is the investigation of choice for diagnosis. Even a macroscopically normal mucosa on endoscopy can have abnormalities such as microscopic colitis and bile acid malabsorption (BAM). The aim of this study was to establish the value of colonoscopy with biopsies in patients with chronic diarrhea and to evaluate the additive value of a SeHCAT test for diagnosing BAM in these patients. METHODS: All patients who underwent a colonoscopy between November 1999 and December 2000 were included. Patient files, colonoscopy and pathology reports and SeHCAT test results were reviewed. RESULTS: 205 patients were included. The most common diagnoses were diarrhea-predominant IBS (n = 76) and IBD (n = 38). 158 patients had non-bloody diarrhea, 113 (72%) of them had a macroscopically normal appearing mucosa. In 40 (35%) of these patients, a histological diagnosis could be made and microscopic colitis was the most common diagnosis (n = 27). SeHCAT test was performed in 36 patients and 15 (42%) of them had BAM. In the 47 patients with bloody diarrhea, IBD was the main diagnosis (n = 23). CONCLUSION: Colonoscopy with biopsies must be performed when investigating chronic diarrhea and BAM should be excluded.     

Immune checkpoint inhibitor-induced diarrhea: Clinicopathological study of 11 patients

We reviewed the records of patients with immune checkpoint inhibitor (ICI)-induced diarrhea during 2015 to 2019. ICI included nivolumab and ipilimumab. There were 11 patients with ICI-induced diarrhea aged 46–81 years (median, 63 years). On colonoscopy, four patients appeared normal, whereas loss of vascularity, erythema, granularity, erosions or ulcerations apparently mimicking ulcerative colitis were found in seven patients. Those seven patients had acute inflammation, cryptitis, crypt abscess and apoptosis, suggestive of ICI-induced colitis. Five of the seven patients were treated with prednisolone, two of whom were resistant to prednisolone and required infliximab. In contrast, none of the four patients without ICI-induced colitis required further treatment. Our observations suggest that diversity exists in the clinical, endoscopic and histological severity of patients with ICI-induced diarrhea. Colonoscopy together with biopsy is inevitable for the diagnosis of ICI-induced colitis, which requires intensive treatment.     

Clostridium difficile diarrhea induced by cancer chemotherapy.

Four patients had diarrhea due to Clostridium difficile after receiving chemotherapy for cancer. None of the patients had received antibiotics for at least 4 weeks before the onset of diarrhea. At the time of admission of any of these four patients no outbreak of diarrhea was noted on the ward. Each patient was admitted with the acute onset of diarrhea after receiving chemotherapy, at different times of the year. Diarrhea was clinically important and was associated with dehydration, toxemia, and blood in the stool in all cases. Diagnosis of C difficile was confirmed by endoscopic examination, positive biopsy specimen, and positive test for toxin in the stool. All patients recovered after undergoing specific treatment. Drugs not believed to carry serious risk to the bowel mucosa may facilitate proliferation of C difficile. Patients with severe diarrhea after receiving chemotherapy, particularly those with blood in the stool, should be promptly tested for C difficile even in the absence of a history of antibiotic administration. Early and specific treatment can prevent additional morbidity and reduce cost of care.