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A Truly Crappy Treatment

A Truly Crappy Treatment

By: Sasha Klemawesch, MD


Many people have heard of C-diff.  If infected, you could be stuck at home in your bathroom with annoying (but benign) diarrhea, or you may wind up in surgery or the ICU with life threatening complications.  And while many people have heard of the disease, few are aware of how difficult it can be to eradicate.

Now get ready for a scary fact.  You might have C-diff.  Yes, you.  In fact, up to 3% of healthy individuals are walking around with it right now, a rate that jumps to 1 in 5 people who’ve been hospitalized ending up colonized with it.  Our GI tracts are home to millions of bacteria, up to 1000 different species at any given time.  But when a good & balanced mix of microbes exists, they all stay in check and actually promote health by doing jobs like making vitamin K, detoxifying chemicals, and augmenting the immune system.  They also make sure that “bad” bacteria don’t get out of control and run amok through your bowels.

This is the problem in C-diff; when you are given an antibiotic for something else, say a skin infection, or pneumonia, it doesn’t just target the one culprit bacteria causing that one infection in that one place; it also kills off a multitude of others, including most of the good guys in your gut.  When this happens, C-diff becomes the dominant force and starts causing distressing pathology.

You may say, “if an antibiotic caused it, why give me another to fix it?”  A good point.  Especially because the antibiotics we have to treat C-diff are often ineffective, and up to a third of people will end up relapsing even if the initial treatment helped.  C-diff is a “spore former” meaning it leaves little hard-shelled spores all over which antibiotics cannot penetrate, so even if the medicine got rid of the active bacteria, the spores are left behind which germinate new bacteria to then resume infecting your gut and releasing their toxins.  It is often a vicious cycle, with subsequent relapse increasing your likelihood of another future episode.

Q – Tips: C. diff

Q – Tips: C. diff

C. diff (Clostridium difficile) is the most common cause of severe antibiotic-induced diarrhea. New research indicates that once an individual has C. diff, it never totally leaves their GI tract. New guidelines therefore, recommend lifelong use of probiotics.

Don’t despair at urgent, post-meal, ‘uh-oh’ moments

Don’t despair at urgent, post-meal, ‘uh-oh’ moments

Postprandial Diarrhea Syndrome (PPDS) – the unexpected and urgent bowel movement shortly after eating a meal – was the topic of a recently review article in The American Journal of Medicine. The authors of this review (from the Mayo Clinic) commented that this condition is often given the all-embarrassing moniker of irritable bowel syndrome (IBS).

But they go on to say that unlike IBS, where no cause is known, PPDS can have a treatable cause. The most common of these are food allergy, celiac disease, maldigestion due to bile acid malabsorption, pancreatic deficiency or an a-glucosidase deficiency.

Food allergy is best diagnosed by allergy skin testing. The treatment is avoidance of the allergenic foods. Celiac disease is an immune (non-allergic) reaction to gluten and can be diagnosed by blood test or intestinal biopsy. Again, the treatment is avoidance of wheat and other grains.

Bile acid malabsorption is best diagnosed by an empirical trial of a taking a bile acid-binding resin. There are sophisticated GI tests that can be done, but these are usually only available in a research medical setting. If the bile-acid binding resin controls the symptoms, then it is continued as a maintenance therapy.

Pancreatic insufficiency (lack of the digestive enzymes produced by the pancreas) can be diagnosed by a fecal fat analysis. Treatment consists of taking replacement pancreatic enzymes orally.

A-glucosidase deficiency is the lack of one or more enzymes that break down certain sugars. The most common ones are deficiency of sucrase, glucoamylase, maltase and isomaltase. Treatment involves avoidance of foods that contain the specific sugars.

Before embarking on a diagnostic trip for PPDS it is important to have proper gastro-intestinal evaluation to rule out more serious underlying conditions, such as cancer, Crohn’s disease or other inflammatory bowel diseases.