Pseudomembranous colitis is an inflammatory condition of the colon characterized by elevated yellow-white plaques that coalesce to form pseudomembranes on the mucosa. Patients with the condition commonly present with abdominal pain, diarrhea, fever, and leukocytosis. Because pseudomembranous colitis is often associated with C. difficile infection, stool testing and empiric antibiotic treatment should be initiated when suspected. When results of C. difficile testing are negative and symptoms persist despite escalating empiric treatment, early gastroenterology consultation and lower endoscopy would be the next step in the appropriate clinical setting. If pseudomembranous colitis is confirmed endoscopically, colonic biopsies should be obtained, as histology can offer helpful clues to the underlying diagnosis. The less common non-C. difficile causes of pseudomembranous colitis should be entertained, as a number of etiologies can result in this condition. Examples include Behcet’s disease, collagenous colitis, inflammatory bowel disease, ischemic colitis, other infections organisms (e.g. bacteria, parasites, viruses), and a handful of drugs and toxins. Pinpointing the correct underlying etiology would better direct patient care and disease management. Surgical specialists would be most helpful in colonic perforation, gangrenous colon, or severe disease.
In this edition of Digestive Endoscopy, Han and colleagues present a prospective double-blind randomized trial comparing the combination of fentanyl and propofol to fentanyl and midazolam in patients aged over 80 years who are undergoing endoscopic retrograde cholangiopancreatogra-phy (ERCP). 1 A total of 100 patients were randomized with the primary outcome being safety and a secondary outcome surrounding the efficacy of ERCP. As opposed to many other studies in this genre, the authors assured the presence of a native papilla and the lack of any post-surgical anatomy in order to reduce any confounding because of altered anatomy. The authors targeted moderate sedation which was defined as a modified assessment of alertness/sedation score of three. Sedation efficacy was assessed by a visual analog scale (VAS) score derived satisfaction analysis and comparison of the induction and recovery times. The groups were well matched for age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, presence of comorbid diseases and baseline physiological data. The incidence of cardiopulmonary complications were the same for both the midazolam and the propofol sedation arms (24% vs 22%). Subcategories of cardiopulmonary complications including hypotension, bradycardia, tachycardia, and hypoxia were the same. There was a trend for increased oxygen supply in the propofol arm (42% vs 32%), but this did not reach statistical significance. Subjects receiving propofol exhibited a significantly shorter recovery time to a modified Aldrete score of 10. Patient, endoscopist and nurse satisfaction were the same between the two sedation arms. Technical procedural success was 100% in both sedation arms. Although procedure time was slightly longer in the propofol arm, this did not reach statistical significance. There are very few studies which address the performance of ERCP in the elderly population. Riphaus et al. random-ized 150 patients to propofol or a combination of meperidine and midazolam. 2 In this study, as well as in others cited below, it is unlikely that patients receiving propofol alone were targeted to moderate sedation owing to the fact that propofol has no analgesic qualities. As such, one would expect be incidence and perhaps the severity of cardiopul-monary unplanned events to be higher. The subjects in this study exhibited a higher comorbidity burden as 91% of them were classified as ASA class III or greater. The incidence of hypoxemia and hypotension was similar between the two sedation arms. Mean recovery time was significantly shorter in patients receiving propofol. Also of note, was that in the recovery phase of the study, the incidence of desaturation was much higher in patients receiving propofol than in those receiving meperidine and midazolam. Schilling and colleagues randomized 150 patients over 80 years old undergoing advanced endoscopic procedures such as balloon enteroscopy, ERCP and endoscopic ultrasonography (EUS) to receive either propofol alone or a combination of mep...
We present the case of a patient who presented with signs and symptoms associated with a Klatskin tumor. After endoscopic retrograde cholangiopancreatography (ERCP) and biopsy, she was found instead to have granulomatous infiltration of the extrahepatic biliary tree consistent with biliary sarcoidosis. The patient was treated successfully with systemic corticosteroids and azathioprine. She later developed cutaneous, lymphatic, and pulmonary granulomatous disease. Isolated biliary disease is a rare initial presentation of systemic sarcoidosis.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.