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Pseudomembranous colitis: how useful is endoscopy?

J M Bergstein1, A Kramer, D H Wittman

  • 1Department of Surgery, Medical College of Wisconsin, Milwaukee 53226.

Surgical Endoscopy
|January 1, 1990
PubMed
Summary
This summary is machine-generated.

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Endoscopy is not a reliable primary diagnostic tool for Clostridium difficile colitis, as noninvasive stool tests are more accurate and cost-effective. This study suggests reserving endoscopy for secondary evaluation in cases of antibiotic-associated diarrhea.

Area of Science:

  • Gastroenterology
  • Infectious Diseases
  • Clinical Diagnostics

Background:

  • Clostridium difficile colitis diagnosis relies on endoscopy or laboratory tests.
  • The role of endoscopy in diagnosing C. difficile colitis requires further clarification.

Purpose of the Study:

  • To evaluate the diagnostic utility and cost-effectiveness of endoscopy in confirmed cases of Clostridium difficile colitis.

Main Methods:

  • Retrospective review of 59 patients with confirmed C. difficile colitis.
  • Analysis of diagnostic yield from stool tests and lower gastrointestinal endoscopy (sigmoidoscopy and colonoscopy).
  • Comparison of treatment efficacy and cost between vancomycin and metronidazole.

Main Results:

Related Experiment Videos

  • Stool tests confirmed C. difficile in all patients.
  • Endoscopy confirmed pseudomembranes in 55% and nonspecific colitis in 14%; diagnosis was never made by endoscopy alone.
  • No significant difference in pseudomembrane detection rates among different endoscopic procedures.
  • Vancomycin and metronidazole showed similar efficacy, but vancomycin was significantly more expensive.

    • Conclusions:

    • Endoscopy is a costly and insensitive method for diagnosing C. difficile colitis.
    • Noninvasive stool tests are accurate and cost-effective for initial diagnosis.
    • Endoscopy should be a secondary tool in evaluating antibiotic-associated diarrhea.