Bergstein J M, Kramer A, Wittman D H, Aprahamian C, Quebbeman E J
Department of Surgery, Medical College of Wisconsin, Milwaukee 53226.
Surg Endosc. 1990;4(4):217-9. doi: 10.1007/BF00316796.
Clostridium difficile colitis may be diagnosed either by endoscopy or by laboratory tests. To determine the role of endoscopy, we reviewed 59 cases of confirmed C. difficile colitis. In all patients, the etiology was confirmed by stool tests. Twenty-nine underwent lower gastrointestinal endoscopy. In 16 (55%) there was endoscopic confirmation of pseudomembranes while 4 (14%) had only nonspecific colitis. There was no apparent difference in the rate of detection of pseudomembranes between rigid sigmoidoscopy (57%), flexible sigmoidoscopy (50%), and colonoscopy (50%). Vancomycin and metronidazole were equally effective therapy but treatment with vancomycin cost more than 250 times that for metronidazole. There were no patients in whom the diagnosis was made by endoscopy alone. Endoscopy was costly and insensitive, while noninvasive stool tests were cheap and accurate. We conclude that endoscopy should be relegated to a secondary role in the workup of antibiotic-associated diarrhea.
艰难梭菌结肠炎可通过内镜检查或实验室检查来诊断。为确定内镜检查的作用，我们回顾了59例确诊的艰难梭菌结肠炎病例。所有患者的病因均通过粪便检测得以证实。29例患者接受了下消化道内镜检查。其中16例（55%）内镜检查证实有假膜形成，4例（14%）仅有非特异性结肠炎。硬式乙状结肠镜检查（57%）、软式乙状结肠镜检查（50%）和结肠镜检查（50%）在假膜检出率上无明显差异。万古霉素和甲硝唑治疗效果相当，但万古霉素治疗费用是甲硝唑的250倍以上。没有患者仅通过内镜检查确诊。内镜检查费用高且不敏感，而无创粪便检测价格低廉且准确。我们得出结论，在内镜检查在抗生素相关性腹泻的检查中应退居次要地位。
