In an electronic letter published in Gut earlier this year,1 I wrote, “Nine years ago I alerted the CDC [US Centers for Disease Control and Prevention] in Atlanta to the possibility that C. difficile colitis might be a marker of a far more common and potentially serious disorder [than C. difficile colitis], ischaemic colitis.”1 The same possibility should be considered in the current outbreak of C. difficile.2
That proton pump inhibitors should be a risk factor3 is of interest in this regard.4 These drugs stimulate cation-dependent short-circuit currents in the colonic mucosa, possibly by converting the vanadate-sensitive H+/K+-ATPase into an electrogenic cation transporter.5 Should the demand for energy from ATP (adenosine triphosphate) hydrolysis so induced exceed the capacity for ATP resynthesis, the action might precipitate an aerobic energy deficit or unreversed ATP hydrolysis similar to that developing for different reasons in ischemic colitis that occurs as a complication of abdominal aortic surgery. As in C. difficile colitis, the passage of liquid, blood-stained stools is an established feature of this condition.
Richard Fiddian-Green Former Professor of General Surgery University of Massachusetts Worcester, Mass.
Footnotes
Competing interests: None declared.
References
- 1.Fiddian-Green RG. C difficile colitis: is it really ischaemic colitis? [letter]. Gut 2004. Available: http://gut.bmjjournals.com/cgi/eletters/53/5/673#417 (accessed 2004 Oct 26). Electronic letter published online only.
- 2.Eggertson L, Sibbald B. Hospitals battling outbreaks of C. difficile. CMAJ 2004;171(1):19-21. [DOI] [PMC free article] [PubMed]
- 3.Dial S, Alrasadi K, Manoukian C, Huang A, Menzies D. Risk of Clostridium difficile diarrhea among hospital inpatients prescribed proton pump inhibitors: cohort and case–control studies. CMAJ 2004;171(1):33-8. [DOI] [PMC free article] [PubMed]
- 4.Thomson RD, Lestina LS, Bensen SP, Toor A, Maheshwari Y, Ratcliffe NR. Lansoprazole-associated microscopic colitis: a case series. Am J Gastroenterol 2002;97(11):2908-13. [DOI] [PubMed]
- 5.Scheiner-Bobis G, Hubschle T, Diener M. Action of palytoxin on apical H+/K+-ATPase in rat colon. Eur J Biochem 2002;269(16):3905-11. [DOI] [PubMed]