Indications and Relative Utility of Lower Endoscopy in the Management of Clostridium difficile Infection

Gastroenterology Research and Practice
Nora E BurkartGenevieve B Melton


Background. Diagnosis and management of Clostridium difficile infection (CDI) rely upon clinical assessments and diagnostic studies. Among diagnostic tests, lower gastrointestinal (GI) endoscopy in the setting of CDI remains controversial. Objective. To describe the role of lower endoscopy in CDI management. Methods. Retrospective study of lower endoscopies in CDI at four metropolitan hospitals, July 2005 through December 2007. Results. Of 1760 CDI inpatients, 45 lower endoscopies were performed on 43 patients. Most common indications were ruling out other etiologies (42%), inconclusive stool studies (36%), and worsening course (11%). Most endoscopies (73%) had positive findings, including pseudomembranous colitis (49%) and nonspecific colitis (24%). Biopsies were performed in 31 cases, more with nonspecific colitis (10/11, 92%) compared to pseudomembranous colitis (14/22, 64%). Conclusion. While not recommended as a primary screening tool, lower GI endoscopy can add valuable information in CDI when other colonic pathologies may exist, studies are inconclusive, or clinical status worsens.


Jan 1, 1990·Surgical Endoscopy·J M BergsteinE J Quebbeman
Oct 1, 1974·Annals of Internal Medicine·F J TedescoD H Alpers
Jun 1, 1993·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Dale N Gerding, J S Brazier
Sep 1, 2004·CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne·Jacques PepinDaniel Chouinard
Nov 13, 2004·Diseases of the Colon and Rectum·Walter E LongoFrank E Johnson
Nov 23, 2006·Annals of Internal Medicine·John G Bartlett
Dec 13, 2006·Epidemiology and Infection·D B ScheurerJ L Schnipper
Jan 2, 2007·Journal of Clinical Gastroenterology·Christina M Surawicz
Apr 5, 2007·Digestive Diseases and Sciences·I StelzmuellerH Bonatti
Feb 7, 2008·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·John G Bartlett, Dale N Gerding
Feb 20, 2008·Archives of Surgery·John C ByrnCelia M Divino
Jun 4, 2008·American Journal of Surgery·Jason F Hall, David Berger
Sep 11, 2008·Scandinavian Journal of Gastroenterology·Kenichi NomuraJapan Hematology/Oncology Study (J-HOST) Group Kyoto
Oct 28, 2008·Dimensions of Critical Care Nursing : DCCN·Megan M Earhart
Dec 17, 2008·Digestive Diseases and Sciences·Sharad SharmaNicolas Jabbour
Apr 1, 2009·Diseases of the Colon and Rectum·Jacques PepinAnnie-Claude Labbé
Apr 9, 2009·Postgraduate Medical Journal·T MonaghanY R Mahida
May 11, 2010·Techniques in Coloproctology·B FarisN Haboubi
Jul 9, 2010·Clinical Microbiology Reviews·J FreemanM H Wilcox
Dec 24, 2010·Annals of the New York Academy of Sciences·John G Bartlett


May 11, 2013·Current Medical Research and Opinion·Chaitanya PantThomas J Sferra
Jun 15, 2013·Current Problems in Surgery·J D StanleyJ H Ashcraft
Mar 22, 2012·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·David L McCollum, J Martin Rodriguez
Apr 2, 2017·Revista de gastroenterología de México·J A Velarde Ruiz-VelascoM R Morfín-Otero
Jul 12, 2018·Medizinische Klinik, Intensivmedizin und Notfallmedizin·F Prechter, A Stallmach
Dec 21, 2012·Expert Review of Anti-infective Therapy·Matteo BassettiM H Wilcox
Jul 16, 2019·La Radiologia medica·Sara GuerriVittorio Miele
Jan 16, 2020·Intensive Care Medicine·Massimo AntonelliMaria Sole Vallecoccia
Dec 10, 2014·Diseases of the Colon and Rectum·Scott R SteeleJanice Rafferty
Mar 27, 2021·Diseases of the Colon and Rectum·Vitaliy PoylinPrepared on behalf of the Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons.

Methods Mentioned


Related Concepts

Trending Feeds


Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Hereditary Sensory Autonomic Neuropathy

Hereditary Sensory Autonomic Neuropathies are a group of inherited neurodegenerative disorders characterized clinically by loss of sensation and autonomic dysfunction. Here is the latest research on these neuropathies.

Spatio-Temporal Regulation of DNA Repair

DNA repair is a complex process regulated by several different classes of enzymes, including ligases, endonucleases, and polymerases. This feed focuses on the spatial and temporal regulation that accompanies DNA damage signaling and repair enzymes and processes.

Glut1 Deficiency

Glut1 deficiency, an autosomal dominant, genetic metabolic disorder associated with a deficiency of GLUT1, the protein that transports glucose across the blood brain barrier, is characterized by mental and motor developmental delays and infantile seizures. Follow the latest research on Glut1 deficiency with this feed.

Separation Anxiety

Separation anxiety is a type of anxiety disorder that involves excessive distress and anxiety with separation. This may include separation from places or people to which they have a strong emotional connection with. It often affects children more than adults. Here is the latest research on separation anxiety.

KIF1A Associated Neurological Disorder

KIF1A associated neurological disorder (KAND) is a rare neurodegenerative condition caused by mutations in the KIF1A gene. KAND may present with a wide range and severity of symptoms including stiff or weak leg muscles, low muscle tone, a lack of muscle coordination and balance, and intellectual disability. Find the latest research on KAND here.

Regulation of Vocal-Motor Plasticity

Dopaminergic projections to the basal ganglia and nucleus accumbens shape the learning and plasticity of motivated behaviors across species including the regulation of vocal-motor plasticity and performance in songbirds. Discover the latest research on the regulation of vocal-motor plasticity here.