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GASTROINTESTINAL INFECTIONS
CLOSTRIDIUM DIFFICILE
(aka “C. DIFFICILE” or “C. DIFF”)
C. diff is short for Clostridium difficile, an infectious bacterium that causes symptoms ranging from diarrhea to life-threatening inflammation of the wall of your colon; a condition known as clostridium difficile colitis. It can produce a range of symptoms.
It is estimated to cause half a million illnesses in the United States each year.
About 1 in 6 patients who get C. diff will get it again in the subsequent 2-8 weeks (about 2 months).
Within a month of diagnosis, 1 in 11 people over age 65 died of a healthcare-associated C. diff infection.
WHAT CAUSES C. DIFFICILE?
C. diff exists all around us. It is in the air, water, soil, and the feces of humans and animals.
C. diff bacteria that are outside the body turn into spores that can live on surfaces for weeks or months. These spores are not "active," but they can turn active after you swallow them, and they get into your intestines. Some people have bacteria in their intestines and never have any symptoms, however, for others, the bacteria make toxins that attack the intestines.
A new strain of C. diff bacteria makes larger amounts of toxins. These types of bacteria are hard to treat with medications.
C. diff bacteria spread in health care facilities, like hospitals or nursing homes, where workers are more likely to encounter it and than with patients or residents.
Between 5 to 15 percent of healthy adults — and 84.4 percent of newborns and healthy infants — have C. diff in their intestines, according to the American College of Gastroenterology (ACG). However, other bacteria that live in the intestines usually keep the amount of C. diff under control.
A C. diff infection occurs when there is too much of the bacterium in your intestines.
WHAT SYMPTOMS DOES IT CAUSE?
The main symptom of a C. diff infection is diarrhea. Other symptoms include:
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abdominal pain or cramps
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nausea
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fever
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loss of appetite
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dehydration
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blood in the stool (in severe cases)
Symptoms of a C. diff infection can range from mild to severe. Call our office if you notice you are having diarrhea three or more times a day, or your symptoms are not going away after two or three days.
You should also seek immediate treatment if you have severe abdominal pain or notice blood in your stool.
HOW DOES C. DIFFICILE SPREAD?
The C. diff bacterium comes from feces. You can develop an infection if you touch a contaminated surface and then touch your mouth.
In addition, the spores of C. diff are resistant to many chemicals used for cleaning. As a result, they can stick around for a long time.
WHO IS MOST LIKELY TO GET AN INFECTION?
While anyone can develop a C. diff infection, some people have an increased risk.
Things that can increase your risk include:
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taking antibiotics, especially a long course of broad-spectrum antibiotics
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spending a lot of time in hospitals
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older age
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having gastrointestinal surgery
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having a weakened immune system
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having chronic kidney or liver disease
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taking proton pump inhibitors (PPIs)
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prior C. diff infection
HOW IS C. DIFFILE DIAGNOSED?
To diagnose a C. diff infection, our skilled specialists will start by asking some questions about your symptoms and medical history. Next, they may order a stool sample. They can analyze it for toxins or toxin genes of the C. diff bacterium.
If your symptoms are severe, they may also perform a procedure called a sigmoidoscopy.
A sigmoidoscopy, also called a flexible sigmoidoscopy, is a procedure that lets your doctor look inside your sigmoid colon by using a flexible tube with a light on it. It helps your doctor check for:
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ulcers
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abnormal cells
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polyps
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cancer
Typically, pieces of tissue will be taken as samples to check for any abnormal cell changes.
HOW IS C. DIFFICILE TREATED?
C. diff infections require treatment with antibiotic therapy. If you are already taking an antibiotic for something else, our doctors may have you stop taking it, if possible.
Common antibiotics used to treat C. diff infections are prescribed based on first-line treatments and the severity of the initial infection.
In most cases, you can take the antibiotics by mouth, which is the standard therapy for the three main C.difficile antibiotics. However, some infections may require intravenous (IV) antibiotic therapy.
The Centers for Disease Control and Prevention (CDC) recommends taking an antibiotic course for at least 10 days to treat a C. diff infection.
In the case of someone with recurrent C. diff who has had at least two recurrences after the first episode, a fecal microbiota transplant may be considered as a potential treatment option, after antibiotic therapy.
As you recover, make sure to drink plenty of fluids. Having diarrhea often leads to dehydration, so it is important to replenish the fluids you lose. In more severe cases, you may need intravenous fluid to treat dehydration as well.
In very rare cases, you may need surgery to remove the affected part of your colon.
ARE THERE ANY COMPLICATIONS?
While most C. diff infections don’t cause any long-term problems, more serious ones can lead to complications, such as:
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Toxic megacolon - swelling and dilation of the large intestine due to inflammation of the intestinal wall and accumulation of excessive amounts of gas.
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Bowel perforation
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Kidney injury. In severe cases of C. diff infection, rapid dehydration can lead to acute kidney injury.
IS C. DIFFICILE PREVENTABLE?
Despite its resistance to many cleaning products, there are several things you can do to prevent yourself from developing or spreading a C. diff infection.
Follow these tips to reduce your risk:
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Wash your hands regularly with soap and warm water. This is especially important after using the bathroom and before eating.
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Do not take antibiotics unnecessarily. Keep in mind that antibiotics are only effective for bacterial infections and will not treat a viral infection, such as the flu or common cold.
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Keep surfaces in high-use areas clean. This includes bathrooms and kitchens. Try to periodically clean these areas with products containing bleach. Bleach is effective against the C. diff bacterium.
WHAT’S THE OUTLOOK?
Once you start taking the antibiotic, you should notice your symptoms start to improve within a day or two. In more severe cases, you may need an IV antibiotic in addition to oral antibiotic therapy.
If you think you have a C. diff infection, contact our office immediately to avoid any complications.
H. PYLORI
WHAT IS AN H. PYLORI INFECTION?
H. pylori is a common type of bacteria that grows in the digestive tract and tends to attack the stomach lining. It infects the stomachs of approximately sixty percent of the world’s adult population. H. pylori infections are usually harmless, but they are responsible for most ulcers in the stomach and small intestine.
The “H” in the name is short for Helicobacter. “Helico” means spiral, which indicates that the bacteria are spiral-shaped.
H. pylori often infect your stomach during childhood. While infections with this strain of bacteria typically do not cause symptoms, they can lead to diseases in some people, including peptic ulcers and an inflammatory condition inside your stomach known as gastritis.
H. pylori are adapted to live in the harsh, acidic environment of the stomach. These bacteria can change the environment around them and reduce their acidity so they can survive. The spiral shape of H. pylori allows them to penetrate your stomach lining, where they are protected by mucus and your body’s immune cells are not able to reach them. The bacteria can interfere with your immune response and ensure that they are not destroyed. This can lead to stomach problems.
WHAT CAUSES H. PYLORI INFECTIONS?
It is still not known exactly how H. pylori infections spread. The bacteria have coexisted with humans for many thousands of years. The infections are thought to spread from one person’s mouth to another. They may also be transferred from feces to the mouth. This can happen when a person does not wash their hands thoroughly after using the bathroom. H. pylori can also spread through contact with contaminated water or food.
The bacteria are believed to cause stomach problems when they penetrate the stomach’s mucous lining and generate substances that neutralize stomach acids. This makes the stomach cells more vulnerable to harsh acids. Stomach acid and H. pylori together irritate the stomach lining and may cause ulcers in your stomach or duodenum, which is the first part of your small intestine.
SYMPTOMS OF H. PYLORI INFECTIONS
Most people with H. pylori do not have any symptoms.
When the infection leads to an ulcer, symptoms may include abdominal pain, especially when your stomach is empty at night or a few hours after meals. The pain is usually described as a gnawing pain, and it may come and go. Eating or taking antacid drugs may relieve this pain.
If you have this type of pain or strong pain that does not seem to go away, you should contact our office.
Several other symptoms may be associated with H. pylori infection, including:
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Excessive burping
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Feeling bloated
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Nausea
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Heartburn
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Fever
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Lack of appetite, or anorexia
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Unexplained weight loss
See your doctor immediately if you experience:
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Trouble swallowing
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Anemia
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Blood in the stool
However, these are common symptoms that could be caused by other conditions. Some of the symptoms of H. pylori infection are also experienced by healthy people.
If any of these symptoms persist or you are concerned about them, it is always best to call our office. If you notice blood or a black color in your feces or vomit, you should contact our office immediately.
RISK FACTORS FOR H. PYLORI INFECTIONS
Children are more likely to develop an H. pylori infection. Their risk is higher mostly due to lack of proper hygiene.
Your risk for infection partly depends on your environment and living conditions. Your risk is higher if you:
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live in a developing country
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share housing with others who are infected with H. pylori
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live in overcrowded housing
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have no access to hot water, which can help to keep areas clean and free from bacteria
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are of non-Hispanic, Black, or Mexican American descent
It is now understood that peptic ulcers are caused by this type of bacteria, rather than stress or eating foods high in acid. About 10 percent of people infected with H. pylori develop a peptic ulcer, according to the Mayo Clinic. Long-term use of non-steroidal anti-inflammatories (NSAIDs) also increases your risk of getting a peptic ulcer.
DIAGNOSING H. PYLORI INFECTIONS
Our specialists will ask about your medical history and family history of the disease. Be sure to tell our physicians about any medications you are taking, including any vitamins or supplements. If you are experiencing symptoms of a peptic ulcer, our specialists will likely ask you specifically about your use of NSAIDs, such as ibuprofen.
Apex ID specialists may also perform many other tests and procedures to help confirm their diagnosis:
Physical exam
During a physical exam, our specialists will examine your stomach to check for signs of bloating, tenderness, or pain. They will also listen for any sounds within the abdomen.
Blood test
You may need to give blood samples, which will be used to look for antibodies against H. pylori.
For a blood test, a healthcare provider will draw a small amount of blood from your arm or hand. The blood will then be sent to a laboratory for analysis. This is only helpful if you have never been treated for H. pylori before.
Stool test
A stool sample may be needed to check for signs of H. pylori in your feces. A sample will be sent to a laboratory for analysis. This and the breath tests usually will require you to stop medications such as antibiotics and proton pump inhibitors (PPIs) before the test.
Breath test
If you have a breath test, you will swallow a preparation containing urea. If H. pylori bacteria are present, they will release an enzyme that breaks down this combination and will release carbon dioxide, which a special device then detects.
Endoscopy
If you have an endoscopy, a thin instrument called an endoscope is inserted into your mouth and down into your stomach and duodenum. An attached camera will send back images on a monitor for review. Any abnormal areas will be inspected. If necessary, special tools used with the endoscope will be used to take samples from these areas.
COMPLICATIONS OF H. PYLORI INFECTIONS
H. pylori infections can lead to peptic ulcers, but the infection or the ulcer itself can lead to more serious complications. These include:
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Internal bleeding, which can happen when a peptic ulcer breaks through your blood vessel and is associated with iron deficiency anemia.
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Obstruction, which can happen when something like a tumor blocks the food from leaving your stomach
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Perforation, which can happen when an ulcer breaks through your stomach wall
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Peritonitis, which is an infection of the peritoneum, or the lining of the abdominal cavity
Studies show that infected people also have an increased risk of stomach cancer. While the infection is a major cause of stomach cancer, most people infected with H. pylori never develop stomach cancer.
TREATMENT OF H. PYLORI INFECTIONS
If you have an H. pylori infection that is not causing you any problems and you are not at increased risk of stomach cancer, treatment may not offer any benefits.
Stomach cancer, along with duodenal and stomach ulcers, is associated with H. pylori infection. If you have close relatives with stomach cancer or a problem such as a stomach or duodenal ulcer, our specialists may want you to have treatment. Treatment can cure an ulcer, and it may reduce your risk of developing stomach cancer.
Medications
You will normally need to take a combination of two different antibiotics, together with another drug that reduces your stomach acid. Lowering stomach acid helps the antibiotics work more effectively. This treatment is sometimes referred to as triple therapy.
Treatment may vary depending on your past medical history and if you have allergies to any of these medications.
After treatment, you will have a follow-up test for H. pylori. In most cases, only one round of antibiotics is needed to clear the infection, but you might need to take more, using different drugs.
Lifestyle and diet
There is no evidence that food and nutrition play a role in preventing or causing peptic ulcer disease in people infected with H. pylori. However, spicy foods, alcohol, and smoking may worsen a peptic ulcer and prevent it from healing properly.
OUTLOOK AND PROGNOSIS
For many people infected with H. pylori, their infections never cause any difficulties. If you are experiencing symptoms and receive treatment; your long-term outlook is generally positive. At least four weeks after finishing your treatment, the specialist will check to make sure it worked. Depending on your age and other medical issues, the specialist may use a urea or stool test to check whether your treatment worked.
If you develop diseases associated with an H. pylori infection, your outlook will depend on the disease, how soon it is diagnosed, and how it is treated. You may need to take more than one round of treatment to kill the H. pylori bacteria.
If the infection is still present after one round of treatment, a peptic ulcer could return or, more rarely, stomach cancer could develop. Very few people infected with H. pylori will develop stomach cancer. However, if you have a family history of stomach cancer, you should get testing and treatment for H. pylori infection.