Current opinion in gastroenterology
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Curr. Opin. Gastroenterol. · Jan 2012
ReviewClostridium difficile infection: an update on epidemiology, risk factors, and therapeutic options.
The incidence and severity of Clostridium difficile infection (CDI) around the world has increased over the past 20 years due to the emergence of hypervirulent strains, increased use and misuse of antibiotics, and the increase of susceptible at-risk populations. Treatments currently available for CDI are inadequate to impede the increasing spread and virulence of the infection, avoid recurrence in chronic patients or prevent infection in at-risk populations. ⋯ The review aims to summarize the most recent evidence available on the epidemiology, risk factors and treatment of CDI. New antibiotics with selected action on C. difficile and limited effect on microflora (fidaxomicin) and donor fecal transplantation seem to have a relevant efficacy in treating CDI and reducing its recurrence. The use of selected monoclonal antibodies directed against C. difficile toxins in addition to standard therapy is a new, promising approach for the treatment of recurrent cases. Vaccination could be an additional weapon against CDI. New robust data are needed before recommendations can be made to abandon current treatment based on vancomycin and metronidazole and move toward new frontiers.
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The major motor functions of the large bowel include storage, propulsion and defecation. New developments continue to expand our knowledge of this area and provide significant advances in the treatment of disorders of colorectal motility. ⋯ The articles referenced in this review inform the reader of new developments in understanding and treating disorders of colonic and anorectal motility and anticipate future advances.