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Paradoxically, in the era of widespread antibiotic therapy, bacteria do not forget about themselves. Antibiotics are a boon of medicine, but as it happens in life, “every medal has two sides.”
The human digestive tract, and especially its final section, i.e. the large intestine (colon), is abundantly colonized by numerous species of bacteria and sometimes fungi (together they form the so-called microflora). This is normal and should not be of concern to anyone. Problems begin when the natural balance in the number and species composition of the microbes in the gut changes.
Disorders of the natural intestinal microflora
This disorder occurs most often when we eat or drink something that was contaminated with pathogenic bacteria, such as Salmonella, Staphylococcus aureus, pathogenic strains of coliform bacteria (Escherichia coli) and many others. Pathogenic bacteria can start to multiply in the digestive tract and symptoms of food poisoning develop.
Another cause of the disturbance of the composition of the natural microflora is the use of antibiotics, which by their nature have an antimicrobial effect. Unfortunately, antibiotics are not intelligent and cannot distinguish between harmless and pathogenic bacteria. Administering antibiotics during a bacterial infection heals the patient and usually eliminates the cause of the disease, but at the same time wreaks a real pogrom among the naturally occurring bacteria in the colon. This causes a huge disturbance of the normal intestinal microflora, which sometimes contributes to the fact that pathogenic microorganisms that are resistant to the administered antibiotic begin to multiply and do not find any competition in the form of bacteria that have been killed by the drug used. In such a situation, another bacterial disease may develop, which affects the gastrointestinal tract.
The causes of pseudomembranous enteritis
Pseudomembranous enteritis (Latin colitis pseudomembranacea) is a disease that attacks most often due to the use of broad-spectrum antibiotics, i.e. those that are able to kill a very wide range of bacterial species. The disease is caused by a rod-shaped, spore-producing (spore) anaerobic bacterium belonging to the species Clostridium difficile. This bacterium occurs naturally in approx. 3% of the human population (colonization) and does not cause any problems. The use of an antibiotic to which it is resistant can cause it to multiply excessively in the intestine. Also, people who have not been colonized with this bacterium before, and who have undergone hospital treatment and simultaneous administration of antibiotics, may become infected with hospital strains of this microorganism, and they may also develop abundant C.I. difficile in the digestive tract. Not every strain of this microorganism must cause the disease, only strains capable of producing toxins (toxins A and B) are responsible for the appearance of symptoms due to the destruction of the intestinal mucosa. Perform a Dispatch Test for Clostridioides difficile and Faecal Toxins A and B to help you determine if you are at risk of having pseudomembranous enteritis.
EnteroDr. in capsules is a dietary supplement containing strains of probiotic yeast that reduce the risk of pseudomembranous enteritis.
Symptoms of enteritis
The name of the disease (pseudomembranous enteritis) comes from the pseudo-membranes that appear in the gut and are visible during colon endoscopy (colonoscopy or rectoscopy). These membranes are made of fibrin, mucus and numerous white blood cells (leukocytes). The presence of membranes is a very important element in the diagnosis of the disease. Other symptoms indicative of this disease are: profuse and watery diarrhea (even a dozen bowel movements a day), possible bloody diarrhea, colic abdominal pain, temperature at least 39 ° C, high leukocytosis (increased amount of leukocytes in the blood). Complications include: dehydration, electrolyte disturbances (disturbed mineral balance), metabolic acidosis (excessive acidification of the blood), shock, intestinal necrosis, sepsis. Remember that pseudomembranous enteritis is always the result of antibiotic treatment. Most often, symptoms appear while the antibiotic is being administered, but it is also possible for the disease to develop up to a month after its discontinuation.
Pseudomembranous enteritis most often affects the elderly. Interestingly, it is practically absent until 6 months of age, despite the fact that Cl is found in the stools of newborns. difficile producing toxins. These babies are likely to have protection in the form of maternal antibodies that persist for some time after birth and are also delivered with her milk. Another explanation is that the gut cells may not yet develop receptors that bind toxins A and B so early in life, which prevents these toxins from working.
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Pseudomembranous enteritis – treatment, diagnosis, prevention
As for treatment, it is mandatory to stop taking the antibiotic that caused the symptoms of the disease. This is often sufficient to resolve symptoms and no further treatment is needed. In more severe cases, it is necessary to use an antibiotic that will be effective in treating infection caused by Clostridium difficile, in addition, patients are rehydrated, high doses of probiotics are administered, fed parenterally, and sometimes surgical intervention is necessary to remove necrotic sections of the intestine.
Diagnostics is mainly based on the microbiological examination of stool samples, on the detection of toxins A and B and on endoscopic diagnostics.
The disease-causing bacterium has the ability to produce spores that are insensitive to the action of antibiotics and can survive in the human body for up to several months. Spores can survive even outside the body, e.g. in a hospital environment, and cause secondary infections. For this reason, it is very important to monitor the patient’s condition for several months after recovery to prevent relapse due to “rebirth” of Cl. difficile from spores.
To reduce the risk of pseudomembranous enteritis, avoid antibiotic treatment when it is not necessary and take preparations containing probiotic bacteria during and after antibiotic therapy, which helps to restore the disturbed intestinal microflora. We recommend, for example, a probiotic to be used during antibiotic therapy Lactibiane ATB containing a specific probiotic strain: Lactobacillus rhamnosus LA 801.
Any diarrhea during or after antibiotic treatment should prompt medical advice.
Text: Tomasz Gosiewski, MD, PhD
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