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miércoles, 4 de mayo de 2016

Pseudomembranous colitis

CCJM 2016 May;83(5):361-366. - 10.3949/ccjm.83a.14183 
"Other causes include other infectious, ischemia, medications, and inflammatory mucosal diseases. 
ABSTRACT
Although Clostridium difficile infection is the cause of most cases of pseudomembranous colitis, clinicians should consider less common causes, especially if pseudomembranes are seen on endoscopy but testing remains negative for C difficile or if presumed C difficile infection does not respond to treatment. Histologic review of colonic mucosal biopsy specimens can provide clues to the underlying cause. 
KEY POINTS 
  • Pseudomembranous colitis is a nonspecific pattern of injury resulting from decreased oxygenation, endothelial damage, and impaired blood flow to the mucosa that can be triggered by a number of disease states. 
  • Chemicals, medications, ischemia, microscopic colitis, other infectious organisms, and inflammatory conditions can all predispose to pseudomembrane formation and should be included in the differential diagnosis. 
  • As most patients with pseudomembranous colitis have C difficile infection, it should be excluded first. Empiric treatment for C difficile should be started if the patient is seriously ill. 
  • Testing for C difficile is with polymerase chain reaction, enzyme immunoassay for toxins A and B, and glutamate dehydrogenase measurement."