title: Interobserver variability and feasibility of polymerase chain reaction-based assay in distinguishing ischemic colitis from Clostridium difficile colitis in endoscopic mucosal biopsies.
abstract: Polymerase chain reaction (PCR)-based assays using stool samples are currently the most effective method of detecting Clostridium difficile. This study examines the feasibility of this assay using mucosal biopsy samples and evaluates the interobserver reproducibility in diagnosing and distinguishing ischemic colitis from C difficile colitis. Thirty-eight biopsy specimens were reviewed and classified by 3 observers into C difficile and ischemic colitis. The findings were correlated with clinical data. PCR was performed on 34 cases using BD GeneOhm C difficile assay. The histologic interobserver agreement was excellent (κ= 0.86) and the agreement between histologic and clinical diagnosis was good (κ = 0.84). All 19 ischemic colitis cases tested negative (100% specificity) and 3 of 15 cases of C difficile colitis tested positive (20% sensitivity). C difficile colitis can be reliably distinguished from ischemic colitis using histologic criteria. The C difficile PCR test on endoscopic biopsy specimens has excellent specificity but limited sensitivity.
authors.affiliation: Dept of Anatomic Pathology, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Homer O
authors.initials: HO
authors.lastname: Wiland
authors.forename: Gary W
authors.initials: GW
authors.lastname: Procop
authors.forename: John R
authors.initials: JR
authors.lastname: Goldblum
authors.forename: Marion
authors.initials: M
authors.lastname: Tuohy
authors.forename: Lisa
authors.initials: L
authors.lastname: Rybicki
authors.forename: Deepa T
authors.initials: DT
authors.lastname: Patil
mesh_terms: D001427:Bacterial Toxins / Q000032:analysis; D001706:Biopsy; D016360:Clostridioides difficile / Q000235:genetics; D003015:Clostridium Infections / Q000175:diagnosis* / Q000473:pathology; D017091:Colitis, Ischemic / Q000175:diagnosis* / Q000473:pathology; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis* / Q000473:pathology; D004768:Enterotoxins / Q000032:analysis; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D016133:Polymerase Chain Reaction / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D001427:Bacterial Toxins; D004768:Enterotoxins
keywords: Clostridium difficile; Endoscopic mucosal biopsies; Ischemic colitis; Polymerase chain reaction