| Usefulness of Sigmoidoscopy in Pseudomembranous Colitis: Focused on the Comparison with Immunological Assay for C. difficile Toxin and the Role as a Predictive Factor for Clinical Outcome |
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Jun-Won Chung, Jeong-Sik Byeon, Kwi-Sook Choi, Benjamin Kim, Seunghyun Kwon, Byong Duk Ye, Seung-Jae Myung, Suk-Kyun Yang, Jin-Ho Kim |
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Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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| 위막성 대장염에 있어 구불결장경검사의 유용성: Clostridium difficile 독소 검사와의 비교 및 예후와의 연관성을 중심으로 |
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정준원, 변정식, 최귀숙, 김병규, 권승현, 예병덕, 명승재, 양석균, 김진호 |
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울산대학교 의과대학 서울아산병원 내과학교실 소화기내과 |
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| Abstract |
Background/Aims
Pseudomembranous colitis (PMC) shows a diverse clinical course. The aim of this study is to evaluate the usefulness of sigmoidoscopy in PMC. Methods: Sigmoidoscopic findings and medical records were analyzed in 74 patients with PMC (male：female=38：36, 62⁑16 years). Sigmoidoscopic grades of PMC were classified into mild (n=45) when pseudomembrane covered ＜1/3 of lumen, moderate (n=18) when it covered 1/3-2/3 of lumen, and severe (n=11) when its extent was ＞2/3 of lumen. Results: In comparison to sigmoidoscopy, diagnostic sensitivity of enzyme immunoassay (EIA) for C. difficile toxin A was 29%. EIA sensitivity was 38% in mild, 28% in moderate, 0% in severe sigmoidoscopic grade (p=0.02). Risk factors for severe sigmoidoscopic grade were ileus, nasogastric tube insertion, and serum albumin below 2.3 g/dL. Initial treatment success rate was lower in severe grade (33%) than mild (96%) and moderate grade (83%) (p＜0.01). One year mortality rate was lower in severe grade (17%) than mild (85%) and moderate grade (84%) (p=0.01). Old age and severe sigmoidoscopic grade were risk factors for death. Conclusions: Sigmoidoscopic severity grading may be useful in the prediction of prognosis in PMC patients. Sigmoidoscopy may also be useful in the diagnosis of PMC, especially in patients with severe PMC. (Intest Res 2007;5:45-51) |
| Key Words:
Enterocolitis, Pseudomembranous, Clostridium difficile, Sigmoidoscopy |
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