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Gastroenterology Research and Practice
Volume 2011, Article ID 626582, 7 pages
Research Article

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

1Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, 420 Delaware Street SE, Mayo Mail Code 450, Minneapolis, MN 55455, USA
2Institute for Health Informatics, Academic Health Center, University of Minnesota, Minneapolis, MN 55455, USA
3Division of Gastroenterology, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA

Received 19 May 2011; Accepted 15 August 2011

Academic Editor: Elizabeth C. Wick

Copyright © 2011 Nora E. Burkart et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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.