Small Bowel Transit Time in Clostridium Difficile Colitis
Small Bowel Transit Time in Clostridium Difficile Colitis
Clostridium difficile is a bacteria that can infect the colon and cause severe diarrhea in
 patients after recent antibiotic use. The current standard of care treatment for severe C.
 diff. consists of oral vancomycin and/or intravenous metronidazole. When treatment is
 unsuccessful, it can lead to need for removal of the entire colon or even death. In fact,
 mortality rates in the literature range from 11-37% for C. diff. The most commonly quoted
 mortality rate is 14% for severe infection. It is believed that the failure of treatment may
 stem from an adynamic ileus (paralysis of the small bowel). This ileus may prevent the oral
 vancomycin from reaching the colon and therefore it does not treat the problem. Vancomycin
 functions by direct contact with the colon. It is presumed that this paralysis of the small
 intestine is present but has never been proven. The objective of the study is to prove that
 there is an adynamic ileus present in c. diff colitis and therefore lead to investigations
 into improved treatment.
Patients in the intensive care unit are eligible to participate in the study A pregnancy test
 will be checked if applicable. Patients that are enrolled and consented in the study will be
 given 300ml of water containing 5 millicurie (mCi) of technetium-99m (Tc-99m)
 diethylenetriamine pentaacetate (DTPA). This nuclear tracer/water mix will either be drank
 orally or placed down a nasogastric tube to begin the study. The patient will have to have
 nothing else to eat or drink for the duration of the study. The patients will have a nuclear
 scan performed at 2, 4, and 6 hours after ingestion of the nuclear tracer. The images at 2
 and 6 hours will be taken in the nuclear medicine department while the 4 hour image will be
 taken in the ICU. The 2 and 6 hour studies must be conducted in the nuclear medicine
 department to allow for special equipment to be used. This equipment is necessary to allow
 for computer calculation to be made. The 4 hour scan is to check for progress of the tracer
 and does not require calculations/measurements. Therefore, a mobile scanner can be utilized.
 The image will be taken for 60 seconds. The images obtained will then be interpreted by the
 nuclear medicine department to determine the transit time of the tracer from the stomach to
 the terminal ileum and cecum. The data obtained from the subjects will be compare to
 previously obtained data for normal subjects. A normal study has been defined as 40% of the
 tracer reaching the terminal ileum by 6 hours. Any time longer than 6 hours is deemed an
 abnormal study with delayed small bowel transit time.
Inclusion Criteria:

 -  ICU patient

 -  positive c. diff PCR or visualization of pseudomembranes on colonoscopy

 -  able to give consent or have representative to give consent

 -  ability to drink contrast or have a previously placed nasogastric tube

 -  approval from the intensivist on duty/ICU Attending physician

 Exclusion Criteria:

 -  Under age 18

 -  pregnant

 -  need for gastric motility medications

 -  need for anti-diarrheal medication

 -  need for surgery

 -  previous small bowel or gastric surgery

 -  inability to drink nuclear tracer without nasogastric tube in place

 -  hypotension requiring vasoactive agents

 -  APACHE II score greater than 30