Pseudomembranous colitis

Tests and procedures used to diagnose pseudomembranous colitis and to search for complications include:

• Stool sample. There are a number of different stool sample tests used to detect Clostridioides difficile (C. difficile) infection of the colon.
• Blood tests. These may reveal an unusually high white blood cell count, called leukocytosis, which may indicate an infection such as C. difficile if you also have diarrhea.
• Colonoscopy or sigmoidoscopy. In both of these tests, your doctor uses a tube with a miniature camera at its tip to examine the inside of your colon for signs of pseudomembranous colitis — raised, yellow plaques called lesions, as well as swelling.
• Imaging tests. If you have severe symptoms, your provider may obtain an abdominal X-ray or an abdominal computed tomography (CT) scan to look for complications such as toxic megacolon or colon rupture.

Treatment strategies include:

• Stopping the antibiotic or other medication that's thought to be causing your symptoms, if possible. Sometimes, this may be enough to resolve your condition or at least ease symptoms, such as diarrhea.

• Starting an antibiotic likely to be effective against C. difficile. If you still experience symptoms, your health care provider may use a different antibiotic to treat C. difficile. This allows typical bacteria to grow back, restoring the healthy balance of bacteria in your colon.

  You may be given antibiotics by mouth, through a vein or through a tube inserted through the nose into the stomach, called a nasogastric tube. Vancomycin or fidaxomicin (Dificid) is most often used, but the choice depends on your condition. If these medicines are not available or you cannot tolerate them, then metronidazole (Flagyl) may be used.

  For severe disease, your provider may prescribe vancomycin by mouth combined with intravenous metronidazole or a vancomycin enema.

• Having fecal microbial transplantation (FMT). If your condition is extremely severe or you have had more than one recurrence of the infection, you may be given a transplant of stool from a healthy donor to restore the balance of bacteria in your colon. The donor stool may be given through a nasogastric tube, inserted into the colon or placed in a capsule you swallow. Doctors may use a combination of antibiotic treatment followed by fecal microbial transplantation (FMT).

Once you begin treatment for pseudomembranous colitis, symptoms may begin to improve within a few days.

Treating recurring pseudomembranous colitis

The natural occurrence of new, more aggressive strains of C. difficile has made treating pseudomembranous colitis increasingly difficult and recurrences more common. With each recurrence, your chance of having an additional recurrence increases.

Treatment options may include:

• Repeat antibiotics. You may need a second or third round of antibiotics to resolve your condition and may need a longer duration of therapy.

• Surgery. Surgery may be an option in people who have progressive organ failure, rupture of the colon and inflammation of the lining of the abdominal wall, called peritonitis. Surgery has typically involved removing all or part of the colon. This is known as a total or subtotal colectomy.

  A newer surgery that involves laparoscopically creating a loop of colon and cleaning it is less invasive and has had positive results. This procedure is known as loop ileostomy and colonic lavage.

• Fecal microbial transplantation (FMT). FMT is used to treat recurrent pseudomembranous colitis. You'll receive healthy, cleaned stool in a capsule, through a nasogastric tube or directly into your colon.
• Bezlotoxumab (Zinplava). The U.S. Food and Drug Administration (FDA) has approved the use of the human monoclonal antibody bezlotoxumab to reduce the risk of recurrence of C. difficile infection. Used in combination with antibiotics, bezlotoxumab has been shown to significantly reduce the recurrence of infection. However, cost may be a limiting factor.

Some research suggests that concentrated supplements of good bacteria and yeasts, called probiotics, can help prevent C. difficile infection, but more studies are needed to determine their use in treating recurrences. They are safe to use and available in capsule or liquid form without a prescription.

To cope with the diarrhea and dehydration that can occur with pseudomembranous colitis, try to:

• Drink plenty of fluids. Water is best, but fluids with added sodium and potassium, known as electrolytes, also may be beneficial. Examples include sports drinks (Gatorade, Powerade, others), oral rehydration solutions (Pedialyte, Ceralyte, others), noncaffeinated soft drinks, broths and fruit juices. Avoid beverages that are high in sugar or contain alcohol or caffeine, such as coffee, tea and colas, which can worsen your symptoms.
• Don't eat foods that worsen symptoms. Stay away from spicy, fatty or fried foods, and any other foods that make your symptoms worse.

Your primary health care provider can usually treat pseudomembranous colitis. Based on your symptoms, you may be referred to a specialist in digestive diseases, known as a gastroenterologist. If your symptoms are particularly severe, you may be told to seek emergency treatment.

Here's some information to help you get ready for your appointment, and what to expect from your provider.

What you can do

When you make the appointment, ask if there's anything you need to do in advance, such as fasting before having a specific test. Make a list of:

• Your symptoms, including any that seem unrelated to the reason for your appointment.
• Key personal information, including major stresses, recent life changes and family medical history.
• All medications, vitamins or other supplements you take, including the doses.
• Questions to ask your provider.

Some basic questions you might want to ask include:

• What's the most likely cause of my symptoms?
• What tests do I need?
• Is my condition likely temporary or long lasting?
• What treatments are available and which do you recommend for me?
• I have other health conditions. How can I best manage them together?
• Are there restrictions I need to follow?
• Should I see a specialist?
• Are there brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask additional questions. And, if possible, take a family member or friend along to help you remember the information you're given.

What to expect from your doctor

Your provider is likely to ask you several questions, such as:

• When did you first begin experiencing signs and symptoms?
• Do you have diarrhea?
• Is there blood or pus in your stools?
• Do you have a fever?
• Are you having abdominal pain?
• Have your symptoms stayed the same or gotten worse?
• During the last several weeks, have you taken antibiotics, had a surgical procedure or been hospitalized?
• Is anyone at home sick with diarrhea, or has anyone at home been hospitalized in the last several weeks?
• Have you ever been diagnosed with diarrhea related to C. difficile or antibiotics?
• Do you have ulcerative colitis or Crohn's disease?
• Are you being treated for any other medical conditions?
• Have you traveled recently to an area with an unsafe water supply?
• Does anything seem to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

What you can do in the meantime

While you're waiting for your appointment, drink plenty of fluids to help prevent dehydration. Sports drinks, oral rehydration solutions (Pedialyte, Ceralyte, others), noncaffeinated soft drinks, broths and fruit juices are good options.