Rice John P, Spier Bret J, Cornett Daniel D, Walker Andrew J, Richie Kelly, Pfau Patrick R
Section of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin Hospital and Clinics, 600 Highland Avenue, Madison, WI 53792-5124, USA.
Transplantation. 2009 Aug 15;88(3):374-9. doi: 10.1097/TP.0b013e3181ae98ab.
Diarrhea is common in solid organ transplant recipients. Colonoscopy with random biopsies is performed frequently in the diagnostic evaluation of the posttransplant population with diarrhea. The purpose of this study was to determine the sensitivity of colonoscopy with random biopsy in determining a specific diagnosis and changing management in solid organ transplant recipients with diarrhea.
From October 1996 to June 2008, 88 patients were identified who had undergone solid organ transplantation and subsequently underwent colonoscopy for an indication of "diarrhea." These patient's electronic medical records were reviewed to determine patient demographics, laboratory results, findings on colonoscopy and histopathology, and any subsequent diagnoses made and management changes in relation to the diarrhea.
Eighty-eight patients (mean age 54 years, 65% male) underwent colonoscopy a mean of 69 months after transplantation. Abnormal colonoscopic findings were seen in 16 (18.2%) patients. Histopathology was abnormal in 17/80 (21.3%). However, only eight (9.1%) had findings on colonoscopy or pathologic condition that led to specific diagnosis being made. In addition, only nine (10.2%) patients had a change in medical management as a direct result of colonoscopy with biopsy.
Although colonoscopic or histopathologic abnormalities are common in the solid organ transplant recipient with diarrhea, the findings rarely lead to a specific diagnosis or management change. Colonoscopy with biopsy should be performed only after noninvasive testing for infectious diarrhea and a thorough review and adjustment of medications. In many patients, a trial of antidiarrheal medication is warranted before colonoscopy.
腹泻在实体器官移植受者中很常见。在对移植后出现腹泻的人群进行诊断评估时，经常会进行结肠镜检查并随机活检。本研究的目的是确定结肠镜检查及随机活检在明确实体器官移植受者腹泻的具体诊断和改变治疗方案方面的敏感性。
从1996年10月至2008年6月，确定了88例接受实体器官移植并随后因“腹泻”指征接受结肠镜检查的患者。回顾这些患者的电子病历，以确定患者的人口统计学特征、实验室检查结果、结肠镜检查和组织病理学检查结果，以及与腹泻相关的任何后续诊断和治疗方案的改变。
88例患者（平均年龄54岁，65%为男性）在移植后平均69个月接受了结肠镜检查。16例（18.2%）患者出现结肠镜检查异常结果。80例患者中有17例（21.3%）组织病理学检查结果异常。然而，只有8例（9.1%）患者的结肠镜检查或病理状况导致了具体诊断。此外，只有9例（10.2%）患者因结肠镜检查及活检直接导致了治疗方案的改变。
尽管结肠镜检查或组织病理学异常在实体器官移植腹泻受者中很常见，但这些结果很少能导致具体诊断或治疗方案的改变。只有在对感染性腹泻进行无创检测并对药物进行全面审查和调整之后，才应进行结肠镜检查及活检。在许多患者中，在进行结肠镜检查之前，有必要试用止泻药物。
