Abstract

Background/Aims
Stool cytotoxin-A assay has been used clinically and commonly for diagnosis of C. difficile associated diarrhea (CDAD). However, the incidence and severity of CDAD show increasing tendency with frequent use of antibiotics, rapid diagnosis is required for severe CDAD. Therefore, we compared diagnostic value of sigmoidoscopy with that of stool cytotoxin-A assay for diagnosis of pseudomembranous colitis (PMC). Methods: During the period from April 2004 to April 2005, a total of 28 cases of suspected CDAD were analyzed prospectively. Both flexible sigmoidoscopy and enzyme immunoassay for stool cytotoxin-A assay were performed and compared with diagnostic yield. The clinical manifestation and used antibiotics were analyzed. Results: The PMC was developed frequently in old age and had clinical symptoms such as diarrhea, abdominal pain and mild fever. The diagnostic yield of stool cytotoxin-A assay was 36.8% while the sigmoidoscopy was 73.6% without significance. With the stool cytotoxin-A assay, the diagnosis for CDAD including PMC was delayed to mean 4.7 days. Conclusions: With increasing use of antibiotics, the incidence and severity of CDAD were increasing. The rapid diagnosis by sigmoidoscopy is more helpful to management of severe CDAD such as PMC than stool cytotoxin-A assay. (Intest Res 2005;3:61-67)

• Keywords: Antibiotic-associated diarrhea, Pseudomembranous colitis, Clostridium difficile toxin A, Sigmoidoscopy