LETTER
Bedside Prediction of Clostridium difficile Colitis
David E. Langdon, MD
15 June 1997 | Volume 126 Issue 12 | Page 1004
TO THE EDITOR:
The John Hopkins group's paper on diagnosing Clostridium difficile colitis [1], several letters to the editor and the Hopkins researchers' reply [2], and Dr. Surawicz's commentary in another journal [3] all discuss clinical associations, laboratory diagnostics, and options. Surprisingly, none mentions that diagnosing this condition is one of the few remaining roles for the highly portable old proctoscope! In these sick patients, if laboratory results are delayed or negative, then, with super suction ready and using left lateral decubitus position (the patient usually in the hospital room and in bed) one can, within a few comfortable inches, appreciate immediately the classic yellowish plaques of pseudomembranous colitis, which rarely spares the rectum. I've seen severe cases of postantibiotic colitis that were toxin-negative by screening tests; a 2- to 3-minute proctal examination revealed classic pseudomembranes and a diagnosis! One efficient clinical look replaced blind empiricism-inexpensive, far simpler than sequential negative laboratory results in a hospitalized patient, and no fiberoptic endoscopy suite charges. Rectal visualization is equally valuable in the office.
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Author and Article Information
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Arlington, TX 76015
1. Manabe YC, Vinetz JM, Moore RD, Merz C, Charache P, Bartlett JG.Clostridium difficile colitis: an efficient clinical approach to diagnosis. Ann Intern Med. 1995; 123:835-40.
2. Vinetz JM, Manabe Y, Bartlett JG. Diagnosis of Clostridium difficile colitis [Letter]. Ann Intern Med. 1996; 125:516.
3. Surawicz CM. World literature review. Am J Gastroenterol. 1996; 91:1662-3.
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