- © 2004 Canadian Medical Association or its licensors
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
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Competing interests: None declared.