Pseudomembranous Colitis is a mucosal illness characterized by many distinct yellow plaques ranging in size from 0-2 to 2-0 cm and adhered to the mucosal surface of a varied length of the colon. It is classified into two types: C. difficile-associated colitis and Pseudomembranous Colitis induced by other causes, with a common pathological route involving mucosal ischemia.
C. difficile is, without a doubt, the most prevalent component linked to Pseudomembranous Colitis caused by past antibiotic usage. Almost all drugs have been connected to C. difficile-associated Pseudomembranous Colitis, with clindamycin and lincomycin being the most heavily implicated (Matsuura, 2017). Pseudomembranous Colitis can occur within days of starting antibiotic medication or up to 6 weeks after it has been ended (Matsuura, 2017). Since the majority of the cases are related to oral rather than parenteral drug use, not only the kind of medications but also the method of delivery impact the development of Pseudomembranous Colitis.
Since the majority of the cases are related to oral rather than parenteral drug use, not only the kind of medications but also the method of delivery impact the development of Pseudomembranous Colitis.
Not only the kind of medications but also the method of delivery impact the development of Pseudomembranous Colitis.
Though it is evident that C. difficile and its toxins cause Pseudomembranous Colitis, the pathogenesis of this disorder is complicated by several unknown variables. C. difficile toxins cause various diseases, from moderate diarrhea to life-threatening Pseudomembranous Colitis (Matsuura, 2017). Additionally, the medicines most commonly involved in PMC are, in fact, efficacious against practically all forms of C. difficile.
There appear to be four critical elements for C. difficile to cause colonic disease: a disruption in the normal bacterial flora in the colonic lumen, an internal or external cause of C difficile, C. difficile toxin synthesis, and age-related predisposition.
If appropriate, treatment techniques include withdrawing the antibiotic or other medicine that is considered to be triggering the signs and symptoms. This may be sufficient to resolve the patient’s illness or, at the very least, to alleviate symptoms such as diarrhea.
Beginning treatment with an antibiotic that is likely to be effective against C. difficile is of utmost importance in the treatment. If a patient continues to experience discomfort, a doctor may prescribe a new medication to treat C. difficile (Aurelia et al., 2020). This permits normal bacteria to regenerate, recreating the patient’s colon’s healthy bacterial balance. Antibiotics may be administered orally, intravenously, or by a tube put through the nose into the stomach (nasogastric tube) (Aurelia et al., 2020). Depending on the situation, vancomycin or fidaxomicin (Dificid) are the most often utilized antibiotics. If these medications are not accessible or are not tolerated, metronidazole (Flagyl) may be administered.
Another therapy option, and most discussed, is fecal microbial transplantation (FMT). Suppose the illness is exceedingly severe or a patient has had more than one recurrent situation of infection. In that case, a stool transplant from a donor may be used to create a balance of bacteria in the colon (Aurelia et al., 2020). Donor stool may be administered by nasogastric tube, implanted into the colon, or contained in a capsule that the patient swallows. Doctors may prescribe antibiotics first, followed by FMT. Common symptoms of pseudomembranous Colitis may diminish within a few days after starting therapy.
Sartelli et al. investigated a comprehensive literature evaluation of FMT therapy for Pseudomembranous Colitis, which was published in 2011 by Gough. FMT was extremely successful in 317 individuals treated throughout 27 case series and reports, with illness remission in 92 percent of instances (Sartelli et al., 2019). In those trials, 35% of patients had fecal microbial transplantation through injection, “with a response rate of 95%; 23% of patients received FMT via naso-jejunal tube by gastroscope, with a response rate of 76%; and 19% via colonoscopy, with a response rate of 89%” (Sartelli et al., 2019, p.19). The efficacy differed depending on the mode of instillation, the connection to the stool donor, the dose of FMT provided, and the therapy is given before administration.
Cammarota produced another comprehensive study that Sartelli et al. investigated. The final analysis comprised 20 full-text case series, 15 case studies, and one randomized controlled research (Sartelli et al., 2019). Despite standard antibiotic therapy, almost all patients treated with donors’ fecal transfusion had recurring bouts of CD-associated diarrhea. In 467 (87%) of the 536 individuals treated, Diarrhea was resolved (Sartelli et al., 2019). Diarrhea remission ratios varied according to infusion site: 81% in the abdomen, 86% in the duodenum/jejunum, 93% in the cecum/ascending colon, and 84% in the small bowel (Sartelli et al., 2019). There were no serious adverse effects recorded as a result of the surgery.
References
Aurelia, H., Sorin, R., Elena, M., Eugen, D., & Magdalena, D. I. (2020). Performance and Consequences for Fecal Transplant in the Treatment of Pseudomembranous Colitis. ARS Medica Tomitana, 26(3), 113-116.
Salen, P., & Stankewicz, H. A. (2017). Pseudomembranous Colitis. StatPearls Publishing.
Sartelli, M., Di Bella, S., McFarland, L. V., Khanna, S., Furuya-Kanamori, L., Abuzeid, N.,… & Catena, F. (2019). 2019 update of the WSES guidelines for the management of Clostridioides (Clostridium) difficile infection in surgical patients. World journal of emergency surgery, 14(1), 1-29.
Matsuura, H. (2017). Pseudomembranous colitis. QJM: An International Journal of Medicine, 110(11), 761-761.