Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
correction of dehydration and
electrolyte (mineral) deficiencies,
discontinuing the antibiotic that caused the
colitis, and
using antibiotics to eradicate the C. difficile bacterium.
In
patients with mild colitis, stopping the antibiotic that caused the infection
may be enough to cause the colitis and diarrhea to subside. In most cases,
however, antibiotics are needed to eradicate the C. difficile bacteria.
Antibiotics that are effective against C. difficile include
metronidazole
(Flagyl), and vancomycin (Vancocin). These two antibiotics usually are taken
orally for 10 days. Both antibiotics are equally effective. With either
antibiotic, fever usually will resolve in one or two days, and diarrhea in three
or four days.
The choice of which antibiotic to use depends on the individual patient's
situation and the preferences of the treating doctor. Some doctors will
prescribe metronidazole first because it is much cheaper than vancomycin.
Vancomycin is reserved for patients who do not respond to metronidazole, are
allergic to metronidazole, or develop side effects from metronidazole. Other
doctors will prescribe vancomycin first for severe colitis because vancomycin
can achieve much higher antibiotic levels in the colon than metronidazole (and
higher antibiotic levels theoretically would be more effective in killing
bacteria).
Why are there relapses of C. difficile colitis?
Approximately 20% of successfully treated patients can experience a relapse of
C. difficile colitis with recurrence of diarrhea, abdominal cramps, and
abdominal pain. Relapses typically occur 3-10 days after vancomycin or
metronidazole is stopped. Some patients experience a second or even a third
relapse after additional courses of antibiotics.
The most likely explanation for relapse is that the C.difficile has not been
completely eradicated by the initial course of antibiotics. C. difficile in its
active bacterial form is killed by either metronidazole or vancomycin, but the
spores are resistant to killing. Several days after stopping antibiotics, the
surviving spores transform into active bacterial forms which will multiply and
produce toxins again.
Another reason
for relapse is the body's inadequate production of antibodies against the
bacterial toxins. Antibodies are proteins that the body produces to fight
bacterial, viral, and parasitic infections, as well as to protect the body from
the harmful effects of toxins. Therefore, adults who are capable of producing
adequate antibodies against C. difficile toxins usually do not develop C.
difficile colitis. Some adults who cannot produce these antibodies are
susceptible to relapses.
Clostridium Difficile Colitis - How Was Diagnosis EstablishedQuestion: What kinds of treatments have been effective for your clostridium difficile colitis (antibiotic-associated colitis, c. difficile colitis)?
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Diarrhea is a change is the frequency and looseness of bowel movements. Cramping, abdominal pain, and the sensation of rectal urgency are all symptoms of diarrhea. Absorbents and anti-motility medications are used to treat diarrhea.
Dehydration is the excessive loss of body water. There are a number of causes of dehydration including heat exposure, prolonged vigorous exercise, and some diseases of the gastrointestinal tract. The best way to treat dehydration is to prevent it from occurring.
Crohn's disease is a chronic inflammatory disease,
primarily involving the small and large intestine, but which can
affect other parts of the digestive system as well. Abdominal pain, diarrhea, vomiting, fever, and weight loss are
common symptoms.
Ulcerative colitis is a chronic inflammation of the colon. Symptoms include abdominal pain, diarrhea, and rectal bleeding. Ulcerative colitis is closely related to Crohn's disease, and together they are referred to as inflammatory bowel disease. Treatment depends upon the type of ulcerative colitis diagnosed.
Although a fever technically is any body temperature above the normal of 98.6 degrees F. (37 degrees C.), in practice a person is usually not considered to have a significant fever until the temperature is above 100.4 degrees F (38 degrees C.). Fever is part of the body's own disease-fighting arsenal: rising body temperatures apparently are capable of killing off many disease- producing organisms.
Stool color is generally brown. When stool color changes, often, an individual becomes concerned. The presence of the bilirubin in bile is generally responsible for stool color. Bilirubin concentration can vary bile color from light yellow to almost black in color. Changes in bilirubin can cause stool to turn green, gray, or clay-like in color. Intestinal bleeding may turn stool black, tarry, red, maroon, or smelly stool. Medication and food may also affect stool color.
Inflammation of the inner lining of the colon is referred to as colitis. Symptoms of the inflammation of the colon lining include diarrhea, pain, and blood in the stool. There are several causes of colitis including infection, ischemia of the colon, inflammatory bowel disease (Crohn's disease, Ulcerative colitis, or microscopic colitis). Treatment depends on the cause of the colitis.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
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