Have you had a stomach ache after taking antibiotics? Let's learn about Pseudomembranous Colitis!

Have you ever had a stomach ache or a stomach bug after taking a course of antibiotics? It usually goes away after a day or two. However, sometimes this condition can be a little more serious. Today we are going to talk about one such serious condition that can be associated with the use of antibiotics. We call this Pseudomembranous Colitis. Although the name may sound a bit strange, it is very important to know about it.

Simply put, what is Pseudomembranous Colitis?

This is a severe inflammation (severe colitis) that occurs in our large intestine (colon), which means swelling and injury. Imagine that something damages the delicate lining (mucosa) inside our large intestine. This damage can be caused by a bacteria, a toxin produced by that bacteria, or another disease.

When this damage occurs, thick, crusty plaques form over the injured areas. Just like a crust forms on our skin when we have a wound. But these are not real crusts. They are made up of dead cells and white blood cells. These yellow-white membranes are what doctors call "pseudomembranes." "Pseudo" means "false." That means they are false membranes. This condition is what we call pseudomembranous colitis.

What are the symptoms of this condition?

A person with this condition may experience a variety of symptoms, but there are a few main things that can be seen.

Why does this kind of disease occur? What is the main cause?

The main and most common cause of this is an infection with the bacteria Clostridium difficile , which we call C. diff for short. This is the cause of more than 90% of cases.

Now you might be wondering how this C. diff bacteria can cause such a disease. The story goes like this:

Millions of bacteria, both good and bad, live in our intestines. These good bacteria do a lot for our bodies. Now imagine that a doctor gives you antibiotics for another illness (for example, a throat infection). These antibiotics kill the bacteria in our bodies. But when they do that, not only the bad bacteria that caused the illness, but also a large number of the good bacteria in our intestines are destroyed.

This overgrowth of C. diff bacteria begins to produce toxins that damage the lining of our large intestine. These toxins cause the intestinal cells to die and become injured, forming the pseudomembranes we talked about earlier.

Antibiotics that most commonly cause C. diff infection

While any antibiotic can cause this risk, some types are more likely to cause this risk. Some of these include:

• Clindamycin
• Types of Cephalosporins
• Types of Penicillin
• Types of Fluoroquinolones

Are there other causes besides C. diff?

Yes. Although C. diff infection is the main cause, this condition can also occur due to other causes, very rarely.

• Other bacterial infections (e.g. *Staphylococcus aureus*, *E. coli*)
• Cytomegalovirus infection
• Reduced blood flow to the colon (Ischemic colitis)
• Some chemotherapy drugs for cancer
• Some autoimmune diseases

Who is most at risk of developing this disease?

Although anyone can develop this condition, some people are at higher risk.

• People receiving treatment in hospitals: Hospitals are places where germs like C. diff can easily spread.
• People who have recently taken antibiotics: As we talked about earlier, this is the main risk factor.
• People over 65 years of age: Because the body's immunity decreases with age.
• People in nursing homes:
• People with weak immune systems: (e.g. HIV infected people, cancer patients)
• People with autoimmune diseases: (e.g. Inflammatory Bowel Disease - IBD)
• People who have previously had a C. diff infection:

What complications could arise if this becomes serious?

This may sound a little scary to you. But remember, these complications often only occur when the disease becomes severe and proper treatment is not given. That's why we recommend seeing a doctor early.

• Dehydration and electrolyte imbalance: When you have 10-15 bowel movements a day, you lose a lot of water and electrolytes. If this becomes severe, it can lead to dangerous conditions like low blood pressure and kidney failure.
• Toxic Megacolon: This is a very dangerous condition. What happens is that the inflammation of the colon becomes so severe that the colon becomes dysfunctional, gas and stool become trapped, and the colon becomes so large that it can burst.
• Gastrointestinal perforation: Severe injuries can cause a hole in the intestinal wall. If this happens, bacteria from the intestine can enter the abdominal cavity and cause life-threatening infections (peritonitis, sepsis).
• Sepsis: A life-threatening condition in which an infection spreads throughout the body and the body's organs begin to fail.

How does a doctor accurately diagnose this disease?

When you go to see a doctor, he or she will ask you about your symptoms, any recent medications you've taken (especially antibiotics), and may then run some tests to confirm the diagnosis.

1. Stool test: This is the most important test. A sample of your stool is taken and tested for the presence of C. diff bacteria or toxins produced by the bacteria.

2. Blood tests: These help to check for infection and elevated white blood cell counts.

3. Colonoscopy: This involves inserting a thin tube with a camera through the anus to examine the inside of the large intestine. This allows us to see with both eyes whether there are any pseudomembranes that we talked about. If necessary, a small piece of tissue (biopsy) can be taken for examination.

What are the treatments for this?

Treatment depends on the cause and severity of the disease.

• Treating the cause: If a C. diff infection is the cause, your doctor will prescribe a specific antibiotic that can kill the bacteria. Metronidazole, Vancomycin, and Fidaxomicin are some of these medications.
• Supportive Care: This may include giving IV fluids to prevent dehydration and giving intravenous nutrition to give the intestines a rest.
• Surgery: In very severe cases, such as complications such as toxic megacolon, surgical removal of the damaged part of the colon (colectomy) may be necessary. However, this is very rare.

What should we do to survive this situation?

Preventing this is very important, especially in places like hospitals and nursing homes.

• Wash your hands often: C. diff is resistant to alcohol-based hand sanitizers, so washing your hands thoroughly with soap and water is the best protection.
• Isolation: In hospitals, patients with C. diff infection are treated in a separate room.
• Cleaning surfaces: C. diff can survive on surfaces for a long time. It is important to clean surfaces regularly with a chlorine-based disinfectant.

When should we see a doctor as soon as possible?

If you have any of the following symptoms, see a doctor immediately or go to a hospital's Emergency Department (ETU).

Although it is common to experience stomach upset after taking antibiotics, it is not always that simple. Sometimes it can be the beginning of a serious condition like Pseudomembranous Colitis. That is why it is very important to listen to your body. If you have any doubts about your symptoms, do not hesitate to talk to your doctor. With proper treatment, you can completely recover from this condition.

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