Pseudomembranous colitis is an inflammation of the colon that occurs during antibiotic therapy. Antibacterial drugs often lead to a violation of the microflora of the gastrointestinal tract. Due to dysbacteriosis, an inflammatory process occurs in the left side of the large intestine. This is accompanied by the appearance of fibrin films (pseudomembranes). The disease is characterized by general intoxication of the body, loss of fluid due to severe diarrhea and impaired water-s alt metabolism. In advanced cases, the pathology is complicated by perforation of the intestinal wall.
Causes of pathology
The etiology of pseudomembranous colitis is associated with the active reproduction of the bacterium Clostridium difficile. This microorganism is found in 3% of adults and about half of children.
The bacterium is considered opportunistic, thenit causes disease only under certain unfavorable conditions. Taking antibiotics can cause Clostridium difficile to take over in the gut. The microorganism releases toxic substances that have a destructive effect on the gastrointestinal tract. The result is pseudomembranous colitis. Inflammation of the colon after antibiotics usually appears with oral medication. However, cases of the disease are occasionally noted after a long course of injections.
Most often, long-term use of "Lincomycin" and "Clindamycin" leads to the development of pathology. In more rare cases, the cause of the disease is the use of "Ampicillin", "Penicillin", "Tetracycline", "Levomycetin", "Erythromycin", as well as medicines from the cephalosporin group.
These drugs not only can disrupt the microflora, but also greatly enhance the effects of Clostridium difficile toxins. There is evidence that pseudomembranous colitis can also occur with prolonged use of cytostatics and frequent use of laxatives.
However, not all patients develop severe dysbacteriosis during the period of treatment with antibacterial drugs. For the occurrence of the disease, additional provoking factors are needed. Inflammation of the colon is most often observed in the following groups of patients:
- older people (over 65);
- renal insufficiency;
- cancer patients;
- patients undergoing major surgery.
These people are more prone to complications after antibiotic therapy.
Is the disease contagious?
Bacteria Clostridium difficile penetrate the body by contact-household way. They get inside a person from contaminated objects through unwashed hands. However, the penetration of microorganisms into the intestine does not always lead to disease. Most often, a person becomes an asymptomatic carrier of bacteria. And only with abuse or prolonged treatment with antibiotics, microbes become active and become pathogenic.
Symptomatics
The symptoms and treatment of pseudomembranous colitis in adults and children depend on the severity of the disease. Pathology can occur in mild, moderate and severe forms.
Mild mild diarrhea occurs while taking antibiotics. After the drug is discontinued, the stool returns to normal, and the signs of the disease subside.
If the disease is moderate or severe, the diarrhea is severe. The stool is watery, the faeces resemble in appearance a decoction of rice. Diarrhea is repeated many times during the day, a person loses a large amount of fluid. Dehydration develops, the balance of water and s alts is disturbed in the body. This is accompanied by the following symptoms of pseudomembranous colitis:
- palpitations;
- sense of crawling "goosebumps" on the body;
- convulsions;
- weakeningmuscle tone.
When the colon is severely damaged, bloody impurities appear in the feces. Signs of intoxication of the body develop:
- temperature increase to +38 degrees;
- weakness;
- pain in the lower left side of the abdomen;
- loss of appetite;
- headache.
In severe forms of pathology, the symptoms do not disappear even after the complete withdrawal of antibiotics.
There are malignant forms of the disease in which symptoms of pseudomembranous colitis develop at lightning speed. Treatment in such cases is often delayed, as the signs of pathology are rapidly increasing. Such forms often end in the death of the patient due to intestinal perforation. With a fulminant course, the signs of the disease resemble those of cholera. There is a strong repeated diarrhea, which leads to a sharp dehydration and an increase in the level of potassium in the blood. This can also cause cardiac arrest and death of the patient.
Features of the disease in children
The main symptoms of pseudomembranous colitis in adults have been described above. Signs of the disease in children have their own characteristics. About half of newborn babies and toddlers under the age of one are carriers of the bacterium Clostridium difficile. However, at the same time, they very rarely have manifestations of the disease, even with a long course of antibiotic therapy. This is due to the fact that special antibodies from mother's milk protect small children from diseases.
However, pseudomembranous colitis, though rare, but stillnoted in childhood. Most often, pathology is observed in the following groups of small patients:
- suffering from inflammatory diseases of the gastrointestinal tract of autoimmune origin;
- leukemia patients;
- children with a congenital defect in the structure of the large intestine (Hirschsprung's disease).
Severe forms of the disease are rarely noted in childhood. Usually colitis occurs with moderate diarrhea, without signs of intoxication. In some cases, there are symptoms of dehydration.
Possible Complications
The most dangerous complication of pseudomembranous colitis is intestinal expansion, which often leads to perforation of its wall.
The pathological condition appears as a result of the action of toxins released by bacteria, as well as dehydration. It is characterized by the following symptoms:
- bloating due to gas accumulation;
- high temperature up to +39…40 degrees;
- reducing diarrhea;
- a sharp deterioration in the general condition.
Expansion of the intestine can lead to a violation of the integrity of its walls. In this case, the clinical picture of peritonitis develops: increased pain in the abdomen, gas and defecation retention, severe weakness.
Treatment of complications of pseudomembranous colitis is carried out only by surgery. In such cases, it is necessary to remove the affected part of the intestine.
Diagnosis
Diagnosis and treatment of pseudomembranous colitis in adults is done by a gastroenterologist. The specialist may suspect the disease already at the stage of collecting an anamnesis. This pathology has characteristic symptoms: the occurrence of diarrhea during antibiotic treatment, combined with signs of intoxication and dehydration.
To differentiate this disease from other forms of colitis, as well as acute poisoning, laboratory and instrumental diagnostic methods are prescribed:
- General blood test. An increase in white blood cells and ESR indicates inflammation.
- Stool analysis (general and bacteria). With the disease, blood is found in the feces, as well as a large amount of mucus and leukocytes. Bacteriological examination determines the causative agent - Clostridium difficile. However, if bacteria are not detected in the feces, this does not always indicate the absence of this pathology.
- Sigmoidoscopy. This endoscopic examination allows you to detect inflamed areas of the intestine covered with fibrinous films.
Drug therapy
First of all, it is necessary to eliminate the very cause of pseudomembranous colitis. Antibiotics are discontinued as soon as the patient develops diarrhea during antibiotic therapy.
Next, it is necessary to influence the pathogenic microflora - the bacterium Clostridium difficile. The microorganism is most sensitive to the drug "Metronidazole". This is the first line medicine for the treatment of pseudomembranous colitis. If the patient has intolerance to Metronidazole, then Vancomycin is prescribed. This drug is alsoeffectively affect the causative agent of pseudomembranous colitis. Clinical guidelines call for the use of such drugs for the treatment of moderate to severe forms of the disease.
With asymptomatic carriage of bacteria, "Metronidazole" and "Vancomycin" are not prescribed. These drugs are not used in mild forms of pathology. In such cases, to normalize the patient's condition, it is enough to stop antibiotics and symptomatic therapy.
It is also necessary to normalize the intestinal microflora. For this purpose, probiotics are prescribed: Bifidumbacterin, Kolibacterin, Bifikol. These drugs should be taken after the end of antibiotic treatment or after the diarrhea has disappeared.
An important role in the treatment of pseudomembranous colitis is played by the fight against dehydration and detoxification therapy. To compensate for the lack of fluid, patients are given droppers with saline solutions. With a large loss of proteins, transfusion of blood plasma is indicated.
To relieve intoxication, patients are prescribed "Cholestyramine" in tablets. This drug neutralizes toxins produced by bacteria.
It is important to remember that with this disease you can not take drugs for diarrhea. This can lead to expansion and perforation of the intestine, as well as to aggravation of intoxication of the body.
Surgical treatment
Surgicalintervention (colonectomy) is indicated for the development of complications, as well as for severe disease. The operation is carried out in two stages. First, the affected part of the large intestine is removed, and the small intestine is brought to the abdominal wall. As a result, discharge from the gastrointestinal tract does not exit through the rectum, but through an opening in the abdomen (ileostomy).
After the condition improves, the second stage of the operation is started. The hole is closed, and the small intestine is connected to the rectum. After that, defecation occurs naturally.
Eating Rules
Following the diet in pseudomembranous colitis plays an important role in the treatment. It helps to restore the intestinal mucosa. Food should be gentle, easy to digest and not irritate the digestive tract.
If you have severe diarrhea, you should follow a starvation diet for the first two days. During this period, you can only drink clean boiled water, unsweetened tea or rosehip broth. Solid foods should be temporarily avoided.
On the third day, jelly can be introduced into the diet without adding sugar. It is allowed to drink kefir, it should not be fresh, but about three days old. You can also eat pureed cottage cheese.
Next, you need to stick to diet number 4-a. Such a table is recommended for patients with acute inflammation of the intestine, accompanied by diarrhea. The following foods are allowed:
- steam cutlets or meatballs made from poultry, lean beef or fish;
- porridge from buckwheat or oats in pureed form;
- low-fat meat and fish soups;
- steam omelette (no more than 1 time perday);
- cottage cheese non-sour mashed;
- zucchini, pumpkin, grated carrots (only as an addition to soups);
- apple puree;
- rosehip broth;
- herbal tea;
- still water.
In this case, you should completely exclude all dishes that can provoke diarrhea. Prohibited products include:
- baked goods;
- porridge from cereals (except buckwheat and oats);
- potato;
- sweets;
- baking;
- pasta;
- confectionery;
- fatty meat and fish;
- high-fat dairy products;
- cheeses;
- kvass and water with gas;
- fresh vegetables;
- legumes;
- sweet fruits;
- milk.
Stay on this diet for some time after the disappearance of symptoms until the intestinal mucosa is completely restored.
Forecast
In mild forms of the disease, the prognosis is favorable. After the abolition of antibacterial drugs and the course of therapy, the pathology is completely cured.
Mild disease can become chronic and often recur.
Severe forms of the disease, even with proper treatment, can end in the death of the patient due to dehydration and metabolic disorders. With a fulminant course, death can occur in the first hours of the disease.
With the development of complications (dilation and perforation of the intestine), the prognosisalways serious. Only an emergency operation can save the patient.
Prevention
You need to be very careful when taking antibiotics. It is necessary to strictly adhere to the prescribed dosage of antibacterial drugs. It is unacceptable to self-medicate. During the course of antibiotic therapy, probiotics should be taken to protect the intestinal microflora and prevent dysbacteriosis.
The elderly, as well as patients with kidney disease and tumors, should avoid taking those antibiotics that can provoke inflammation of the colon. Also, you should not uncontrollably take laxatives for constipation. If diarrhea occurs after taking antibacterial drugs, you should immediately consult a doctor.
