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 digestive tract. Due to dysbiosis, an inflammatory process occurs in the left part 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-salt 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 active reproduction of the bacterium Clostridium difficile. This microorganism is observed in 3% of adults and about half of the children.
The bacterium is considered opportunistic, that is, it causes the disease only under certain unfavorable conditions. Taking antibiotics can cause Clostridium difficile to begin to prevail in the intestines. The microorganism releases toxic substances that have a devastating effect on the digestive tract. As a result, pseudomembranous colitis occurs. Inflammation of the colon after antibiotics usually occurs with oral administration of drugs. However, occasionally there are cases of the disease after a long course of injections.
Most often, the development of pathology leads to a long reception of "Linkomycin" and "Clindamycin." In more rare cases, the cause of the disease is the use of Ampicillin, Penicillin, Tetracycline, Chloramphenicol, Erythromycin, as well as medications from the cephalosporin group.
These drugs can not only disrupt the microflora, but also many times increase the effect of toxins of the bacterium Clostridium difficile. 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 dysbiosis during treatment with antibacterial drugs. For the occurrence of the disease, additional provoking factors are necessary. Inflammation of the colon is most often observed in the following groups of patients:
- elderly people (over 65 years old);
- suffering from kidney failure;
- cancer patients;
- patients undergoing severe surgery.
These people are more likely to experience complications after antibiotic therapy.
Is the disease contagious?
Bacteria of Clostridium difficile penetrate the body through a contact-household route. They enter a person from infected objects through unwashed hands. However, the penetration of microorganisms into the intestines 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.
Symptomatology
Symptoms and treatment of pseudomembranous colitis in adults and children depend on the degree of the disease. Pathology can occur in mild, moderate and severe form.
With a mild form, mild diarrhea occurs while taking antibacterial drugs. After drug withdrawal, the stool normalizes and the symptoms of the disease subside.
If the disease occurs in moderate or severe form, then diarrhea is severe. The stool is watery, feces resemble a decoction of rice in appearance. Diarrhea is repeated many times during the day, a person loses a large amount of fluid. Dehydration develops, in the body the balance of water and salts is disturbed. This is accompanied by the following symptoms of pseudomembranous colitis:
- heart palpitations;
- sensation of creeping "goosebumps" in the body;
- cramps
- weakening of muscle tone.
With severe damage to the colon in the feces appears bloody admixture. The signs of intoxication of the body develop:
- temperature increase to +38 degrees;
- weakness;
- pain in the lower left abdomen;
- loss of appetite;
- headache.
In severe forms of pathology, the symptoms do not disappear even after the complete discontinuation 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 perforation of the intestine. In case of lightning fast, the signs of the disease resemble the symptoms of cholera. There is severe repeated diarrhea, which leads to a sharp dehydration and an increase in the level of potassium in the blood. This can also cause the cessation of cardiac activity 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 infants and toddlers under the age of one year are carriers of the bacterium Clostridium difficile. However, at the same time, they rarely have manifestations of the disease, even with a long course of antibiotic therapy. This is due to the fact that young children are protected from diseases by special antibodies from mother's milk.
However, pseudomembranous colitis, although rare, is nevertheless noted 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 colon (Hirschsprung’s disease).
In childhood, severe forms of the disease are rarely observed. Typically, colitis occurs with mild diarrhea, with no signs of intoxication. In some cases, symptoms of dehydration are observed.
Possible complications
The most dangerous complication of pseudomembranous colitis is an expansion of the intestine, which often leads to perforation of its wall.
The pathological condition appears as a result of the action of toxins secreted by bacteria, as well as dehydration. It is characterized by the following symptoms:
- bloating due to gas congestion;
- high temperature up to +39 ... 40 degrees;
- decreased diarrhea;
- a sharp deterioration in general condition.
The 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 retention and defecation, severe weakness.
The treatment of complications of pseudomembranous colitis is carried out only surgically. In such cases, it is necessary to remove the affected part of the intestine.
Diagnostics
A gastroenterologist is involved in the diagnosis and treatment of pseudomembranous colitis in adults. A specialist may suspect a disease already at the stage of collecting an anamnesis. This pathology has characteristic symptoms: the occurrence of diarrhea during antibiotic treatment in combination 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.
- Fecal analysis (common and for bacteria). With the disease, blood is found in the feces, as well as a large amount of mucus and white blood cells. In bacteriological research, the pathogen Clostridium difficile is determined. However, if bacteria are not detected in the feces, then 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 canceled immediately, as soon as the patient shows diarrhea on the background of antibiotic therapy.
Next, you need to act on the pathogenic microflora - the bacterium Clostridium difficile. The microorganism is most sensitive to the drug "Metronidazole". This is a first-line medication for the treatment of pseudomembranous colitis. If the patient has intolerance to Metronidazole, then Vancomycin is prescribed. This drug is also able to effectively affect the causative agent of pseudomembranous colitis. Clinical recommendations include the use of such drugs for the treatment of moderate and severe forms of the disease.
With asymptomatic carriage of bacteria, Metronidazole and Vancomycin are not prescribed. These drugs are not used for mild forms of pathology. In such cases, the abolition of antibiotics and symptomatic therapy is sufficient to normalize the patient's condition .
It is also necessary to normalize the intestinal microflora. For this purpose, probiotics are prescribed: "Bifidumbacterin", "Colibacterin", "Bificol." These drugs should be taken after treatment with antibacterial drugs or after the disappearance of diarrhea.
An important role in the treatment of pseudomembranous colitis is played by dehydration control and detoxification therapy. To make up for the lack of fluid, patients are given droppers with saline solutions. With a large loss of proteins, a blood transfusion is indicated.
To relieve intoxication, patients are prescribed "cholestyramine" in tablets. This drug neutralizes toxins released 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.
Surgery
Surgical intervention (collectomy) is indicated for the development of complications, as well as for severe illness. 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, the discharge from the gastrointestinal tract does not exit through the rectum, but through an opening in the abdomen (ileostomy).
After improvement, they proceed to the second stage of the operation. The hole is closed, and the small intestine is connected to the straight line. After this, defecation is carried out naturally.
Nutrition rules
Diet for pseudomembranous colitis plays an important role in treatment. This helps restore the intestinal mucosa. Food should be gentle, easy to digest and not irritate the digestive tract.
With severe diarrhea, a starvation diet should be followed in the first two days. During this period, you can only drink clean boiled water, unsweetened tea or a rosehip broth. Solid foods should be temporarily discarded.
On the third day, you can introduce jelly in the diet without adding sugar. It is allowed to drink kefir, it should not be fresh, but about three days ago. You can also eat curd in pureed form.
Next, you need to adhere to diet No. 4-a. This table is recommended for patients with acute inflammation of the intestine, accompanied by diarrhea. The following foods are allowed:
- steam cutlets or meatballs from poultry meat, low-fat beef or fish;
- buckwheat or oat porridge;
- soups from lean meat and fish;
- steam omelet (not more than 1 time per day);
- non-acidic curd;
- squash, pumpkin, carrots in pureed form (only as an additive in soups);
- applesauce;
- rosehip broth;
- Herb tea;
- still water.
In this case, all dishes that can cause diarrhea should be completely eliminated. Prohibited foods include:
- bakery products;
- cereals from cereals (except buckwheat and oats);
- potatoes;
- sweets;
- bakery products;
- pasta;
- confectionery;
- fatty meat and fish;
- high fat sour milk products;
- Cheeses
- kvass and water with gas;
- fresh vegetables;
- legumes;
- sweet fruits;
- milk.
It is necessary to adhere to this diet for some time after the disappearance of symptoms until the intestinal mucosa is completely restored.
Forecast
With mild forms of the disease, the prognosis is good. After the cancellation of antibacterial drugs and the course of therapy, the pathology is completely cured.
A disease of moderate severity can become chronic and often recur.
Severe forms of the disease, even with proper treatment, can result in the death of the patient due to dehydration and metabolic disorders. With a lightning fast, a fatal outcome can occur in the first hours of the disease.
With the development of complications (expansion and perforation of the intestine), the prognosis is always serious. Only an emergency operation can save the patient.
Prevention
Great care must be taken 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 dysbiosis.
Elderly people, as well as patients with kidney diseases and tumors, should avoid taking those antibiotics that can provoke inflammation of the colon. Also, laxatives should not be taken uncontrollably for constipation. If you experience diarrhea after using antibacterial drugs, you should immediately consult a doctor.