Acute Bloody Diarrhea: A Medical Emergency for Patients of All Ages

Department of Pediatrics, Division of Gastroenterology and Nutrition, Washington University School of Medicine, St Louis, Missouri 63110, USA.
Gastroenterology (Impact Factor: 16.72). 06/2009; 136(6):1887-98. DOI: 10.1053/j.gastro.2009.02.059
Source: PubMed


Acute bloody diarrhea should be considered a medical emergency. Its causes are frequently serious or actionable or both and are usually identified. However, acute bloody diarrhea as a stand-alone clinical presentation has received little scholarly attention in the past several decades. Although the range of possible causes of acute bloody diarrhea is broad, infectious considerations are paramount and should always be prioritized in the evaluation of such patients. History, examination, and laboratory testing should be focused on minimizing time to diagnosis (and, by extension, to implementing appropriate therapy). Strategically chosen tests and imaging, avoidance of extraneous diagnostic pursuits, and provision of supportive care while awaiting diagnostic clarity are central to the adroit management of patients with acute bloody diarrhea. Diagnostic considerations differ somewhat between adults and children but have many elements in common, including the need for vigilance in detecting Escherichia coli O157:H7 infection. In this review, we discuss diagnostic approaches (emphasizing the importance of rapid, accurate, and thorough microbiologic investigation) and measures that can be taken to support patients while awaiting information that determines the cause of their disease. These topics are discussed in the context of the medical care that is available to children and adults with bloody diarrhea in most institutions in developed nations.

Download full-text


Available from: Lori R Holtz, Aug 21, 2014
  • Source
    • "Various microbiological and immunological tests are performed on stool samples when patients with diarrhea are admitted to the hospital. However, these tests have limited sensitivity with respect to antibiotic consumption and/or low antigen burdens [5] [6]. 1043-4666/Ó 2014 The Authors. "
    [Show abstract] [Hide abstract]
    ABSTRACT: There are no rapid tests that can distinguish contagious gastroenteritis, which requires isolation at its onset, from exacerbation of chronic inflammatory bowel disease (IBD) or bowel engagement in the course of systemic inflammatory response syndrome (SIRS). Hepatocyte growth factor (HGF) is an acute phase cytokine that is produced at the site of injury. It has high affinity to sulfated glycan, and this binding affinity is lost during chronic inflammation. The fecal pH strongly impacts the prognosis for severe bowel disease. We developed a strip test to evaluate HGF as a local acute phase response marker in the bowel. This test assessed the binding affinity of HGF to sulfated glycans in fecal samples and determined fecal pH as an indicator of illness severity.
    Full-text · Article · Aug 2014 · Cytokine
  • Source
    • "The most available procedures that are undertaken to establish diagnosis in patients with diarrhea by examination of stool are direct microscopy, cultures, parasitological examinations , PCR and Elisa tests to identify virus, determination of hemoglobulin, calprotectin and toxins. However , with respect to antibiotic consumptions and/or low antigen burden the tests have a limited sensitivity [1] [2]. "

    Full-text · Article · Feb 2013 · Open Journal of Gastroenterology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Houttuynia Cordata Thunb (HCT; Saururaceae), known as ‘Eosungcho’ in Korea, has been traditionally used for antibiotic treatment and has proved its effect through clinical demonstrations. In spite of it s being used quite frequently in traditional prescriptions because of its superior antibiotic effect, HCT’s molecular mechanisms on its antibiotic effect have not been understood. Hence, this is the first study about HCT’s antibiotic mechanisms at the molecular level. HCT was extracted to acquire the fractions, then inoculated to confirm its antibiotic effect toward the bacteria Escherichia coli O157:H7 (E. coli O157:H7; ATCC 43894) through the disc diffusion method. The antibacterial efficacy of HCT was measured by diameter of cleared zone. Thereafter, we isolated the RNA of affected cells and analyzed it’s expressions through the microarray. To confirm the accuracy of the acquired data, RT-PCR was carried out. Results from this study indicate that E. coli O157:H7 exposures to HCT fractions, a number of genes that have been related to the synthesis of bacterial cell wall are downregulated, while some of the cell wall synthesis inhibitory genes are upregulated. Both results indicate that HCT fractions inhibit cell wall synthesis as like as β-lactam antibiotics. Furthermore, a few genes that have a critical role to DNA replication are downregulated. These genes, including folA, are closely related to the folate biosynthesis. Remarkable abnormal regulations that show antibiotic resistance activity of the E. coli O157: H7 are found, and are seem to be closely linked to the multidrug efflux pumps, especially upregulation of marRAB operon. The results of this study improve our understanding of the mode of action of HCT on E. coli O157:H7 and may show the usefulness of HCT fractions in the antibacterial treatment. Keywords Houttuynia Cordata Thunb-Antibiosis- folA-Multidrug efflux pump-Cell wall inhibition
    Full-text · Article · Sep 2010 · BioChip journal
Show more