The surgeon and clostridium difficile colitis

John Stanley, Donald Barkel, J. Daniel Stanley, Donald Barrel

Research output: Contribution to journalArticle

Abstract

The history of CDC provides a very interesting example of how medical knowledge is acquired and integrated into successful patient care. PMC was first described by Finney in 1893.2 In the 1950s through the early 1970s, Staphylococcus aureus, viruses, and ischemia were thought to be causative agents. During that period of time, administration of antibiotics emerged as the greatest risk factor for the development of PMC. Three classic studies, Tedesco's3 report on the endoscopic characterization of PMC, Green's4 original description of Clostridium difficile cytotoxin, and a comprehensive thesis on Clostridium difficile by Hafiz,5 were all written in 1974. This foundation of information led to a rapid improvement in the understanding of PMC. Clostridium difficile is a gram positive anaerobic bacillus that was first described in 1935 by Hall and OToole.6 Clostridium difficile produces toxins A and B. Toxin A accounts for changes in the gastrointestinal tract, and Toxin B has a cytotoxic effect on cultured cells.7 The gold standard assay for detecting Clostridium difficile is based on detecting the rounding effect that toxin B has on cultured cells. Commercial cytotoxin immunoassays are now available that are rapid, inexpensive, and accurate. Appropriate management is based on prevention, early diagnosis, and medical treatment. Oral vancomycin and oral Flagyl have proven their therapeutic efficacy with Flagyl being much less expensive. Intravenous Flagyl can be used in the patient who cannot take oral medication. Intravenous vancomycin is ineffective because of its lack of GI secretion. The vast majority of patients with PMC are successfully treated medically, often in an outpatient setting. The studies reviewed here reveal a role for surgical management in the few patients progressing to severe PMC. There may be an opportunity for initial or continued medical care in this setting. However, when faced with a patient who is critically ill from PMC, surgical intervention is appropriate and may be lifesaving. Decision making in this setting requires a careful history and physical examination, selective use of endoscopie and imaging studies, and sound clinical judgment. Once the decision to operate is made, the procedure of choice is total abdominal colectomy and ileostomy to remove the septic focus. Treatment options when the colon appears only mildly edematous are controversial, but it may be most wise to err toward resection. The surgeon's role in this disease is not limited to operation. Careful attention to proper antibiotic use, especially when used for surgical prophylaxis, may reduce the incidence of this disease. An awareness of the increasing incidence of PMC combined with a knowledge of proper diagnostic techniques and medical management will further reduce the number of patients progressing to severe disease requiring surgical management. Our understanding of PMC is relatively recent but is increasing as summarized in several recent excellent reviews.8,10 A challenge remains to better define patients who fall into the category of severe colitis and to prospectively evaluate the treatment options.

Original languageEnglish (US)
Pages (from-to)316-319
Number of pages4
JournalCurrent Surgery
Volume53
Issue number6
StatePublished - Dec 1 1996
Externally publishedYes

Fingerprint

Clostridium difficile
Colitis
Metronidazole
Disease
management
incidence
Cytotoxins
Vancomycin
early diagnosis
prophylaxis
gold standard
history
physician's care
History
patient care
medical care
Anti-Bacterial Agents
Ileostomy
diagnostic
medication

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Stanley, J., Barkel, D., Daniel Stanley, J., & Barrel, D. (1996). The surgeon and clostridium difficile colitis. Current Surgery, 53(6), 316-319.

The surgeon and clostridium difficile colitis. / Stanley, John; Barkel, Donald; Daniel Stanley, J.; Barrel, Donald.

In: Current Surgery, Vol. 53, No. 6, 01.12.1996, p. 316-319.

Research output: Contribution to journalArticle

Stanley, J, Barkel, D, Daniel Stanley, J & Barrel, D 1996, 'The surgeon and clostridium difficile colitis', Current Surgery, vol. 53, no. 6, pp. 316-319.
Stanley J, Barkel D, Daniel Stanley J, Barrel D. The surgeon and clostridium difficile colitis. Current Surgery. 1996 Dec 1;53(6):316-319.
Stanley, John ; Barkel, Donald ; Daniel Stanley, J. ; Barrel, Donald. / The surgeon and clostridium difficile colitis. In: Current Surgery. 1996 ; Vol. 53, No. 6. pp. 316-319.
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