Overview
Diagnosis
To diagnose the cause of diarrhea and confirm pseudomembranous colitis, a health care provider may use several tests. A stool sample is usually the primary test to detect C. diff bacteria, their toxins or other infectious organisms. Blood tests may show a high white blood cell count, which can support the diagnosis when diarrhea is present. A colonoscopy or flexible sigmoidoscopy may be done to view the inside of the colon and collect a biopsy to rule out other conditions. Imaging tests such as an X-ray or CT scan can help identify complications, including toxic megacolon or bowel perforation.
Treatment
Treatment for pseudomembranous colitis focuses on addressing the underlying infection and managing complications. Rehydration is an important first step, often using fluids and essential minerals delivered through a vein to restore typical levels. If the condition is linked to an antibiotic, that medicine is stopped unless it is essential for treating another illness. A targeted antibiotic is then used to treat the C. diff infection while allowing healthy bacteria to recover. Commonly used antibiotics include vancomycin, fidaxomicin and metronidazole. When needed, bezlotoxumab may be added to help prevent recurring infections.
Restoring healthy bacteria in the colon may be recommended if symptoms persist. Fecal microbiota transplantation uses healthy donor stool to repopulate the gut with beneficial bacteria. This can be delivered during a scope procedure through the anus, through a tube placed through the nose to the stomach, by an enema or by swallowing a pill that contains inactive bacteria.
In severe cases with serious colon damage, rupture or toxic megacolon, surgery may be required. Surgical options include removing the entire colon, removing only the diseased portion and reconnecting the healthy sections or temporarily diverting stool through an opening in the belly wall while the colon is treated and healed.
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