Bellaiche G, Le Pennec M P, Slama J L, Ley G, Choudat L, Giacomini T, Godefroy Y, Paugam B
Service de Gastroenténtrologie, Centre Hospitalier, Génèral Robert Ballanger, Aulnay-Sous-Bois.
Ann Gastroenterol Hepatol (Paris). 1996 Jan-Feb;32(1):11-7.
The goal of this study was to evaluate the contribution of sigmoidoscopy with bioptic microbiology to the etiologic diagnosis of acute diarrhea in adults. Patients and methods. Sixty-five patients with acute diarrhea were included prospectively from February 1993 to November 1994. Ages ranged from 17 to 83 years. In each patient, two stool samples were cultured and three examined for parasites. Clostridium difficile toxin was looked for in the 18 patients who had taken antimicrobials before onset of the diarrhea. Sigmoidoscopy with collection of biopsy specimens for bacteriologic cultures was performed routinely. Results. A pathogenic organism was identified in 35 patients (54%). Eighteen patients (28%) had positive stool cultures. Clostridium difficile toxin was detected in six patients. Colonic biopsy cultures were positive in 26 patients (40%). Endoscopic findings established the diagnosis of pseudomembranous colitis with negative tests for C. difficile toxin in two patients, diverticulitis in one, ischemic colitis in two, and cryptogenic colitis in seven. Conclusions. Sigmoidoscopy ensured the diagnosis in over 72% of cases of acute diarrhea. This investigation complements stool cultures and should be done routinely in adults with severe acute diarrhea.
本研究的目的是评估乙状结肠镜检查结合活检微生物学对成人急性腹泻病因诊断的贡献。患者与方法。1993年2月至1994年11月前瞻性纳入65例急性腹泻患者。年龄范围为17至83岁。对每位患者，培养两份粪便样本，并检查三份样本中的寄生虫。对腹泻发作前服用过抗菌药物的18例患者检测艰难梭菌毒素。常规进行乙状结肠镜检查并采集活检标本进行细菌培养。结果。35例患者（54%）鉴定出致病生物体。18例患者（28%）粪便培养阳性。6例患者检测到艰难梭菌毒素。26例患者（40%）结肠活检培养阳性。内镜检查结果确诊2例艰难梭菌毒素检测阴性的伪膜性结肠炎、1例憩室炎、2例缺血性结肠炎和7例隐源性结肠炎。结论。乙状结肠镜检查在超过72%的急性腹泻病例中确保了诊断。这项检查补充了粪便培养，对于严重急性腹泻的成人应常规进行。
