title: Clostridium difficile-associated diarrhea with hematochezia is associated with ulcer formation.
abstract: OBJECTIVE
  Clostridium difficile-associated diarrhea (CDAD) is a well-known iatrogenic infection with typical endoscopic features including pseudomembranes and intervening normal mucosa. Clinically, diarrhea frequently occurs, but occurrence of hematochezia is rare. The objective of this study was to investigate the background and endoscopic features of CDAD patients with hematochezia.
  
  
  METHODS
  The endoscopic and clinical findings in 12 patients who showed evidence of C. difficile toxin A and who underwent colonoscopy between April 2002 and July 2007 were investigated retrospectively.
  
  
  RESULTS
  Eight patients were diagnosed as having CDAD and 4 patients had a diagnosis of ulcerative colitis. Six of the patients with CDAD presented with hematochezia, and 4 of them were diagnosed with hematological malignancies and received anticancer chemotherapy. Colonic ulcer was demonstrated in all CDAD patients with hematochezia, and bleeding from the ulcer was endoscopically confirmed in all of them.
  
  
  CONCLUSIONS
  CDAD accompanied by hematochezia is closely associated with ulcer formation. Ulcers are thought to occur during recovery from nadir after anticancer treatment, and white blood cells appear to be essential for their formation. Physicians should therefore pay close attention to the occurrence of colonic ulcer, especially in patients with CDAD during recovery from nadir.
authors.affiliation: Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan.
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Morimoto
authors.forename: Kenichi
authors.initials: K
authors.lastname: Nomura
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Tsutsumi
authors.forename: Muneo
authors.initials: M
authors.lastname: Ohshiro
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Fujimoto
authors.forename: Daisuke
authors.initials: D
authors.lastname: Shimizu
authors.forename: Naoki
authors.initials: N
authors.lastname: Wakabayashi
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Konishi
authors.forename: Shoji
authors.initials: S
authors.lastname: Mitsufuji
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Matsumoto
authors.forename: Masafumi
authors.initials: M
authors.lastname: Taniwaki
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003108:Colonic Diseases / Q000175:diagnosis / Q000209:etiology*; D003113:Colonoscopy; D003937:Diagnosis, Differential; D004761:Enterocolitis, Pseudomembranous / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D014456:Ulcer / Q000175:diagnosis / Q000209:etiology*
chemical_list: D000900:Anti-Bacterial Agents