title: [Probiotic therapy of pseudomembranous colitis. Combination of intestinal lavage and oral administration of Escherichia coli].
abstract: METHODS
  An 82-year-old woman was admitted because of acute left heart failure with pulmonary oedema. There was a right basal pneumonia with congestion which was treated with amoxycillin and clavulanic acid. Severe watery diarrhoea with more than 10 stools daily occurred. Clostridium difficile was not isolated.
  
  
  METHODS
  Coloscopy as far as the right flexure revealed proximally increasing whitish coatings, like those in severe pseudomembranous colitis (PMC), revealed as acute erosive colitis histologically. The plate-like incomplete erosions contained fibrin and granulocyte deposits so typical of PMC. Clostridium difficile could again not be demonstrated.
  
  
  METHODS
  As intestinal lavage, already undertaken in preparation of the coloscopy, markedly improved the symptoms it was repeated for therapeutic purposes. This brought about further improvement and a fall in granulocyte count from 29,500 G/l to 10,700 G/l. Subsequently live E. coli bacteria (nissle 1917 strain) were administered. After 5 days stool frequency had fallen to one or two daily, each soft or partly formed. Stools were normal after a further week. Coloscopy 3 weeks after onset of treatment showed almost complete healing of the PMC.
  
  
  CONCLUSIONS
  The successful treatment of PMC with intestinal lavage and physiological E. coli administration agrees with the results of animal experiments and clinical experience. Whether it is an effective alternative to primary standard treatment with vancomycin or metronidazole remains to be tested by further experience, preferably properly controlled therapeutic trials.
authors.affiliation: Medizinische Klinik, Kliniken St. Antonius, Wuppertal.
authors.forename: K J
authors.initials: KJ
authors.lastname: Goerg
authors.forename: E
authors.initials: E
authors.lastname: Schlörer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003106:Colon / Q000473:pathology*; D003113:Colonoscopy; D004761:Enterocolitis, Pseudomembranous / Q000628:therapy*; D004926:Escherichia coli; D005260:Female; D006801:Humans; D019936:Probiotics / Q000627:therapeutic use*; D007507:Therapeutic Irrigation
vernacular_title: Probiotische Therapie einer pseudomembranösen Kolitis. Kombination aus intestinaler Lavage und oraler Gabe von Escherichia coli.