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Cureus 2021 Apr 29;13(4):e14751. Epub 2021 Apr 29.

General Surgery, MacDill Air Force Base (AFB), Tampa, USA.

Clostridium difficle (C. diff) is a well known cause of infectious diarrhea across hospitals in the developed world. An anaerobic, gram positive rod bacteria, C. Read More

Gastroenterol Clin North Am 2021 Jun;50(2):323-340

Department of Medicine, Division of Infectious Diseases, William S. Middleton Memorial Veterans Hospital, University of Wisconsin-Madison, Madison, WI, USA. Electronic address:

Antibiotic-associated diarrhea and Clostridioides difficile infection (CDI) occur frequently among adults. The pathophysiology of CDI is related to disruption of normal gut flora and risk factors include hospitalization, use of antibiotic therapy, and older age. Clinical manifestations can range from mild disease to toxic megacolon. Read More

Cureus 2021 Apr 11;13(4):e14414. Epub 2021 Apr 11.

Gastroenterology, Wayne State University, Detroit, USA.

Ipilimumab and nivolumab are immune checkpoint inhibitors that have recently been used in the treatment of metastatic melanoma and other cancers. Immune-mediated colitis is one of their adverse events that need to be differentiated from low-grade diarrhea as one of the most common side effects. A 51-year-old woman with relapsed metastatic melanoma presented with intractable diarrhea, nausea, vomiting, and generalized abdominal pain. Read More

World J Emerg Surg 2021 May 11;16(1):23. Epub 2021 May 11.

Department of Surgical Sciences, Policlinico Sant'Orsola Malpighi, Bologna, Italy.

Background: Despite the current therapeutic options for the treatment of inflammatory bowel disease, surgery is still frequently required in the emergency setting, although the number of cases performed seems to have decreased in recent years. The World Society of Emergency Surgery decided to debate in a consensus conference of experts, the main pertinent issues around the management of inflammatory bowel disease in the emergent situation, with the need to provide focused guidelines for acute care and emergency surgeons.

Method: A group of experienced surgeons and gastroenterologists were nominated to develop the topics assigned and answer the questions addressed by the Steering Committee of the project. Read More

World J Clin Cases 2021 May;9(13):3219-3226

Department of Internal Medicine, São Paulo State University (Unesp), Medical School, Botucatu 18618687, São Paulo, Brazil.

Background: Acute severe ulcerative colitis (ASUC) is a complication of ulcerative colitis associated with high levels of circulating tumor necrosis factor alpha, due to the intense inflammation and faster stool clearance of anti-tumor necrosis factor drugs. Dose-intensified infliximab treatment can be beneficial and is associated with lower rates of colectomy. The aim of the study was to present a case of a patient with ASUC and megacolon, treated with hydrocortisone and accelerated scheme of infliximab that was monitored by drug trough level. Read More

Medicine (Baltimore) 2021 May;100(18):e25772

Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

Rationale: Gastrointestinal tract duplication is a rare congenial anomaly which can be found anywhere along the gastrointestinal tract. While many patients are incidentally diagnosed during operation, in some cases it can present with severe gastrointestinal symptoms. In this case report, the patient presented with signs of toxic megacolon leading to rapid aggravation of inflammatory shock. Read More

Infect Dis Ther 2021 Jun 26;10(2):687-697. Epub 2021 Mar 26.

Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA.

Clostridium difficile infection (CDI) is a leading cause of healthcare-associated infections, accounting for significant disease burden and mortality. The clinical spectrum of C. difficile ranges from asymptomatic colonization to toxic megacolon and fulminant colitis. Read More

Biotechnol Prog 2021 Mar 5:e3141. Epub 2021 Mar 5.

Laboratorio de Biofarmacéuticos Recombinantes, Facultad de Ciencias Químicas, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico.

Gastrointestinal infections caused by Clostridium difficile lead to significant impact in terms of morbidity and mortality, causing from mild symptoms, such as a low-grade fever, watery stools, and minor abdominal cramping as well as more severe symptoms such as bloody diarrhea, pseudomembrane colitis, and toxic megacolon. Vaccination is a viable approach to fight against C. difficile and several efforts in this direction are ongoing. Read More

Gut Microbes 2021 Mar 4:1-8. Epub 2021 Mar 4.

Unit of Infectious Diseases and Clinical Microbiology. Jerez De La Frontera University Hospital, Jerez De La Frontera, Cádiz, Spain.

To study the association between detection of the gene encoding the binary toxin (CDT) and direct detection of toxinB (TcdB) from feces with the appearance of serious disease, complications, or recurrence in a prospective series of cases. A total of 220 confirmed cases were included, using a two-step algorithm: an initial study to detect the enzyme, glutamate dehydrogenase (GDH), followed, in cases of positivity, by detection of the tcdB. tcdB-positive patients were investigated for the presence of CDT and TcdB. Read More

Microorganisms 2021 Feb 2;9(2). Epub 2021 Feb 2.

Synthetic Biology Research Centre, The University of Nottingham Biodiscovery Institute, University Park, Nottingham NG7 2RD, UK.

is the main cause of health-care-associated infectious diarrhoea. Toxins, TcdA and TcdB, secreted by this bacterium damage colonic epithelial cells and in severe cases this culminates in pseudomembranous colitis, toxic megacolon and death. Vaccines in human trials have focused exclusively on the parenteral administration of toxin-based formulations. Read More

Nat Commun 2021 01 19;12(1):462. Epub 2021 Jan 19.

Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC, 27607, USA.

Clostridioides difficile is a bacterial pathogen that causes a range of clinical disease from mild to moderate diarrhea, pseudomembranous colitis, and toxic megacolon. Typically, C. difficile infections (CDIs) occur after antibiotic treatment, which alters the gut microbiota, decreasing colonization resistance against C. Read More

Infect Dis Clin Pract (Baltim Md) 2020 Jan;28(1):10-15

Department of Medicine, Division of Hematology and Oncology, University of Arizona, Tucson, AZ 85724.

Introduction: The aim of our study is to evaluate risk factors associated with the development of infection (CDI) in hematopoietic stem cell transplant (HSCT) patients, determine its incidence and report outcomes of CDI in our patient population.

Methods: We performed a retrospective review of medical records of adult HSCT recipients diagnosed between 2013 and 2016 at our center. Logistic regression models were used to determine the relationship between risk factors and the odds of CDI. Read More

Rev Esp Enferm Dig 2021 Mar;113(3):189-192

Digestive Diseases, Hospital Universitario de Basurto, España.

Toxic megacolon is most commonly considered as a complication of inflammatory bowel disease, especially ulcerative colitis and colonic Crohn's disease to a lesser extent. It appears in the context of moderate-to-severe disease and often requires colectomy. Currently, after an inadequate response to conventional therapy with systemic corticosteroids, the use of cyclosporine or infliximab is considered as an alternative option, prior to surgical intervention. Read More

Pediatr Int 2020 Dec 17;62(12):1401-1403. Epub 2020 Nov 17.

Department of, Pediatric Surgery, Miyazaki Prefectural Miyazaki Hospital, Miyazaki-shi, Miyazaki, Japan.

Radiography (Lond) 2021 05 12;27(2):716-720. Epub 2020 Nov 12.

Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Introduction: Toxic megacolon is a rare but life-threatening condition. Diagnosis is made when both systemic toxicity and an enlarged colon are present. We undertook a systematic review of the literature to provide a list of toxic megacolon findings on computed tomography (CT) imaging along with the prevalence rate for each finding. Read More

BMC Gastroenterol 2020 Nov 12;20(1):377. Epub 2020 Nov 12.

Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.

Background: We aimed to characterize the trends of prognosis in ulcerative colitis (UC) and Crohn's disease (CD) in a Chinese tertiary hospital.

Methods: A 30-year retrospective cohort analysis was conducted at Peking Union Medical College Hospital. Consecutive patients newly diagnosed with UC or CD from 1985 to 2014 were included. Read More

Curr Opin Gastroenterol 2021 Jan;37(1):66-75

University of Texas School of Public Health.

Purpose Of Review: To provide the definition, causes, and current recommendations for workup and treatment of acute infectious colitis in adults, a common medical problem of diverse cause.

Recent Findings: The management of acute colitis in adults depend upon establishment of cause. Most forms of infectious colitis are treatable with antimicrobials. Read More

Open Forum Infect Dis 2020 Oct 21;7(10):ofaa366. Epub 2020 Aug 21.

Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA.

Background: Inappropriate testing for leads to overdiagnosis of infection (CDI). We determined the effect of a computerized clinical decision support (CCDS) order set on polymerase chain reaction (PCR) test utilization and clinical outcomes.

Methods: This study is an interrupted time series analysis comparing PCR test utilization, hospital-onset CDI (HO-CDI) rates, and clinical outcomes before and after implementation of a CCDS order set at 2 academic medical centers: University of Washington Medical Center (UWMC) and Harborview Medical Center (HMC). Read More

Curr Opin Crit Care 2020 12;26(6):648-657

Department of Critical Care Medicine, University of British Columbia, Vancouver, British Columbia.

Purpose Of Review: The aim of this study was to describe important features of clinical examination for the surgical abdomen, relevant investigations, and acute management of common surgical problems in the critically ill.

Recent Findings: Lactate remains a relatively nonspecific marker of gut ischemia. Dual energy computed tomography (DECT) scan can improve diagnosis of bowel ischemia. Read More

Dig Liver Dis 2021 Apr 10;53(4):403-408. Epub 2020 Oct 10.

Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Division of Colon and Rectal Surgery, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy. Electronic address:

Ulcerative colitis, a chronic inflammatory condition that affects the colon from rectum to caecum, is characterized by periods of increased bowel movements, blood in feces, rectal urgency, tenesmus, and abdominal pain, with periods of remission and flares of disease, which negatively impact quality of life. A number of therapeutic options are available for patients with moderate-to-severe ulcerative colitis, however, no clear treatment algorithm exists. Therapeutic goals include short-term benefits for patients (i. Read More

Environ Pollut 2021 Jan 5;268(Pt B):115713. Epub 2020 Oct 5.

Department of Biotechnology, Daegu University, Jillyang, Naeri-riGyeongsan, Gyeongbuk, 38453, Republic of Korea. Electronic address:

This study focused on the possible chemo-preventive effects of insect peptide CopA3 on normal human colon cells against the inflammation induced by the toxic environmental pollutant aflatoxin B1 (AFB1). In the study, we used CCD 841 CoN normal human colon cells to investigate the cytotoxic effect induced by AFB1 and elucidated the negative impact of AFB1 exposure on the cell cycle progression. Further, we also carried out the in-vivo experiment, where male BALB/c mice were administrated with AFB1 to induce inflammation associated cancer like phenotype and the dietary effect of CopA3 was evaluated on the early stages of AFB1-induced hepatotoxicity and inflammation in colon tissues. Read More

Anesth Prog 2020 09;67(3):158-163

Department of Anesthesiology, Kanagawa Dental University Hospital, Yokosuka, Kanagawa, Japan.

Inflammatory bowel disease (IBD) is a group of chronic inflammatory disorders of the gastrointestinal tract including ulcerative colitis (UC) and Crohn's disease. Pain management can be challenging in patients with IBD because there are limitations on the use of analgesics. Use of nonsteroidal anti-inflammatory drugs is not recommended in patients with IBD because there is risk of relapse of IBD and an overall increase in disease activity. Read More

Biomedicines 2020 Sep 8;8(9). Epub 2020 Sep 8.

Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy.

infection (CDI) is the leading cause of antibiotic-associated diarrhea, especially in hospitalized elderly patients, representing a global public health concern. Clinical presentations vary from mild diarrhea to severe pseudomembranous colitis that may progress to toxic megacolon or intestinal perforation. Antibiotic therapy is recognized as a risk factor and exacerbates dysbiosis of the intestinal microbiota, whose role in CDI is increasingly acknowledged. Read More

J Microbiol Immunol Infect 2020 Aug 12. Epub 2020 Aug 12.

Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Center of Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan. Electronic address:

Background: Clostridium difficile infections (CDIs) cause significant mortality and morbidity. Critically ill patients are susceptible to CDIs and tend to have severe CDIs, and their clinical presentations are not merely diarrhea.

Materials And Methods: From September 2017 to March 2018, the adults with CDIs in the ICUs were included. Read More

Ann R Coll Surg Engl 2020 Sep 17;102(7):e176-e179. Epub 2020 Aug 17.

Department of General and Digestive Surgery, University Hospital of Móstoles, Madrid, Spain.

Spain has been one of the most affected countries by the COVID-19 outbreak. After the high impact of the pandemic, a wide clinical spectrum of late complications associated with COVID-19 are being observed. We report a case of a severe colitis in a post-treatment and recovered COVID-19 patient. Read More

Z Gastroenterol 2020 Aug 12;58(8):778-784. Epub 2020 Aug 12.

Klinik für Innere Medizin IV (Gastroenterologie, Hepatologie und Infektiologie), Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Deutschland.

infections (CDI) are typical antibiotic therapy associated complications. Notwithstanding the fact that the clinical picture of may extend to the development of a toxic megacolon with potentially life-threatening sequelae, mild infectious forms associated with uncomplicated diarrhoea are by far the most prevalent and should also be treated according to clear clinical practice guidelines. However, there are currently conflicting international guidelines governing metronidazole-based treatment of mild infections. Read More

Am J Surg 2021 01 21;221(1):240-242. Epub 2020 Jun 21.

Department of Surgery, Abington Hospital, Jefferson Health, USA.

Background: Clostridioides difficile infection (CDI) is traditionally taught to be an antibiotic associated diarrheal infection. This diagnosis is based on the presence of clinical symptoms (usually defined as more than 3 watery, loose or unformed stool within 24 h) coupled with a diagnostic test. There is now a new presentation of CDI, including progression to toxic megacolon, in patients without diarrhea. Read More

South Med J 2020 Jul;113(7):345-349

From the Division of Trauma & Surgical Critical Care and the Department of Research Administration, Jersey Shore University Medical Center, Neptune, New Jersey.

Objective: The purpose of the study was to evaluate whether early colectomy in patients who have toxic megacolon due to colitis reduces mortality.

Methods: The study was performed using the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2016. All patients 18 to 89 years of age who underwent colectomy for toxic megacolon resulting from colitis were included in the study. Read More

Surg Today 2021 Feb 23;51(2):181-186. Epub 2020 Jun 23.

Department of Pediatric Surgery, Graduate School of Medical Sciences, Reproductive and Developmental Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.

Hirschsprung's disease (HD) is a congenital disease manifesting various degrees of functional bowel obstruction caused by the absence of enteric ganglion cells, which are usually absent in the colonic segment of the HD patient. Because the aganglionic segment of HD always includes the rectum, pathological diagnosis can be made using a rectal sample. HD should be diagnosed as early as possible because serious complications, such as acute enterocolitis or toxic megacolon, can develop without a definitive diagnosis and appropriate treatment. Read More

Clin Exp Gastroenterol 2020 19;13:203-210. Epub 2020 May 19.

Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV, USA.

Toxic megacolon (TM) is one of the fatal complications of inflammatory bowel disease (IBD) or any infectious etiology of the colon that is characterized by total or partial nonobstructive colonic dilatation and systemic toxicity. It is associated with high morbidity and mortality, and surgical management is necessary for the majority of the cases. An accurate history and physical examination, plain radiographs of the abdomen, sigmoidoscopy, and, most important of all, awareness of the condition facilitate diagnosis in most cases. Read More