The most common side effects are diarrhea or loose stools, nausea, abdominal pain, and vomiting which may occur in fewer than one in twenty persons who receive azithromycin. All samples should be delivered to the laboratory within two hours as delays in delivery may lead to drops in stool pH, thus suppressing the growth of some bacteria including Shigella. Giving azithromycin as 2 divided doses on the same day may limit this adverse event. Coformulations with bismuth subnitrate are available in Korea for acute diarrhea patients. The leukemoid reaction may be observed in shigellosis. Symptoms of salmonellosis include diarrhea, bloody stools, fever, and headache. government site. Salmonella, Campylobacter, Shigella, and STEC are the most common pathogenic bacteria causing acute bloody diarrhea. ASGE Standards of Practice Committee. Hemoglobin levels close to normal ranges may indicate dehydration. Although aortitis and infectious aneurysm are very rare, they often have unfavorable prognosis and are caused by Gram-positive bacteria including Staphylococcus, Enterococcus, and Streptococcus pneumoniae. Combination of doxycycline and gentamicin. There also are significant deviations in agglutinin levels in healthy populations in community; this is because the level may change with time and vary depending on how endemic enteric fever is in a given area [30]. In 50-80% of TD cases, TD is caused by bacterial infection. Antimotility agents for the treatment of. Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. Symptoms of Campylobacteriosis include abdominal cramps, bloating and fever. Adsorbents, such as kaolin, pectin, charcoal, and attapulgite, do not decrease the frequency or duration of diarrhea and, thus, are not recommended in infectious diarrhea [96,97]. Therefore, the use of antibiotics is not recommended for patients with suspected or confirmed STEC infections. DuPont HL, Ericsson CD, DuPont MW, Cruz Luna A, Mathewson JJ. Before . . These CT findings may help in differential diagnosis of the cause of acute diarrhea [45]. Although its incidence is on a decreasing trend, typhoid fever introduced from other countries has increased owing to increases in travels to other countries and foreign nationals living in Korea [5]. Diarrhea is a common concern. Antibiotic treatment of traveler's diarrhea (usually a quinolone) is associated with decreased severity of illness and a two-or three-day reduction in duration of illness.1,42 If the patient's clinical presentation suggests the possibility of Shiga toxinproducing E. coli (e.g., bloody diarrhea, history of eating seed sprouts or rare ground beef, proximity to an outbreak), antibiotic use should be avoided because it may increase the risk of hemolytic uremic syndrome.43 Conservative management without antibiotic treatment is less successful for diarrhea lasting more than 10 to 14 days, and testing and treatment for protozoal infections should be considered.1 Antibiotics may be considered in patients who are older than 65 years, immunocompromised, severely ill, or septic. Salazar-Lindo E, Santisteban-Ponce J, Chea-Woo E, Gutierrez M. Racecadotril in the treatment of acute watery diarrhea in children. Therefore, this testing has fallen out of favor.18, Lactoferrin is a marker for leukocytes that is released by damaged or deteriorating cells, and increases in the setting of bacterial infections.19 Commercially available immunoassay testing kits are a more precise and less variable method for specimen analysis compared with fecal leukocytes, with a sensitivity greater than 90% and a specificity greater than 70%.20 Although there is some debate as to whether fecal lactoferrin is clearly superior to fecal leukocytes, the speed and simplicity of lactoferrin testing make it the preferred method to screen for the presence of leukocytes when indicated.21, The indiscriminate use of stool cultures in the evaluation of acute diarrhea is inefficient (results are positive in only 1.6% to 5.6% of cases)1 and expensive, with an estimated cost of $900 to $1,200 per positive stool culture.22 Obtaining cultures only in patients with screening tests positive for leukocytes decreases the cost to $150 per positive culture.23 Obtaining cultures only in patients with grossly bloody stools increases the yield for positive culture results to greater than 30%.24, Although there is no consensus on which patients need a culture, it is reasonable to perform a culture if the patient has grossly bloody stool, severe dehydration, signs of inflammatory disease, symptoms lasting more than three to seven days, or immunosuppression.25,26 Cultures are often obtained for traveler's diarrhea; however, empiric treatment is also an option.1,11 In the hospital setting, cultures should be reserved for the reasons listed above or if diarrhea begins more than three days after admission and there has been a nosocomial outbreak, the patient has human immunodeficiency virus infection or neutropenia, or the patient is older than 65 years with significant comorbidity (e.g., end-stage liver, renal, or pulmonary disease; leukemia hemiparesis caused by cardiovascular accident; inflammatory bowel disease).25. PMC legacy view Instead, personnel may wait days and only request medical attention if symptoms persist or worsen. The Korean Society of Infectious Diseases, Korean Society for Chemotherapy, The Korean Society of Clinical Microbiology. The duration of diarrhea was significantly (p=0.0002) shorter following treatment with azithromycin plus loperamide (11 h) than with either dose of azithromycin alone (34 h). Salmonella, Campylobacter, Yersinia, or Shigella should be considered first if persistent fever and systemic symptoms are present [7]. The antisecretory drug racecadotril, widely used in Europe but unavailable in the United States, appears to be more tolerable and as effective as loperamide.41. To counter a mild loss of fluids from diarrhea, drink more water or drinks that contain electrolytes. Oral: For the treatment of mild to moderate community-acquired pneumonia due to C pneumoniae, H influenzae, M pneumoniae, or S pneumoniae in patients appropriate for oral therapy Usual Adult Dose for Mycoplasma Pneumonia Patients who require initial IV therapy: IV: 500 mg IV once a day for at least 2 days On radiological findings, hyperplasia of bowel walls may lead to empty lumen sign in infectious diarrhea, as well as relatively less fat stranding compared to inflammatory bowel disease or ischemic enteritis. The committee members who participated in developing this guideline were not influenced by any means by government organizations, academic societies, pharmaceutical companies, or other for-profit institutions. Guidelines for the prevention and treatment of travelers' diarrhea: a graded expert panel report. Cover TL, Aber RC. Zhou Y, Zhu X, Hou H, Lu Y, Yu J, Mao L, Mao L, Sun Z. Characteristics of diarrheagenic, Thakur N, Jain S, Changotra H, Shrivastava R, Kumar Y, Grover N, Vashistt J. Molecular characterization of diarrheagenic. The intestinal parasite Cryptosporidium, which causes diarrhea and dehydration, can be eliminated via azithromycin. Probiotic use may shorten the duration of illness. Ischemic enteritis often invades the sigmoid colon or splenic flexure, and mesenteric infiltration is a major radiological finding. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Clinical practice. The abdominal examination is important to assess for pain and acute abdominal processes. The protective effect of azithromycin against dysenteric diarrhea has been accidentally discovered during malaria chemoprophylaxis efficacy trial in Kenya in 1995. If trophozoite is found in duodenal biopsy and aspiration, Giardiasis can be diagnosed [55,56], and duodenal aspiration is also useful for suspected Strongyloides, Cystoisospora, or Microsporidia infection [57]. Dewey-Mattia D, Manikonda K, Hall AJ, Wise ME, Crowe SJ. Watery or bloody diarrhea (this can occur up to several months after you stop taking azithromycin) Sudden dizziness or fainting Fast or pounding heartbeat Notify your healthcare provider if you experience symptoms of potential liver problems, such as: Nausea or vomiting Appetite loss Stomach pain Fatigue Itching Dark urine Clay-colored stools A randomized, blinded trial. Non-typhoidal Salmonella, Campylobacter, Shigella, Listeria, non-cholera Vibrio, and Yersinia may cause invasive infections and infectious diarrhea in many immune-suppressed patients, and blood culture may be employed to identify the pathogen and test for antibiotic sensitivity [32,33,34,35,36]. Holtz LR, Neill MA, Tarr PI. Do probiotics decrease the duration of symptoms in acute infectious diarrhea? Even when bacterial in etiology, the symptoms often improve spontaneously without treatment, and treatment does not necessarily shorten the duration of symptoms. Vandenplas Y. Lactobacillus reuteri DSM 17938 effectively reduces the duration of acute diarrhoea in hospitalised children. My heart rate and blood pressure went up to 178/ . Conflict of Interest: No conflicts of interest. and norovirus are common causes of diarrhea after consumption of uncooked seafood or shellfish, and diarrhea after consumption of uncooked meat or poultry may be caused by Shiga toxin-producing Escherichia coli (STEC) (beef), C. perfringens (beef and poultry), Salmonella (poultry), Campylobacter (poultry), Yersinia (pork and pork intestine), Staphylococcus aureus (poultry). azithromycin is also used sometimes to treat h. pylori infection, travelers' diarrhea, and other gastrointestinal infections; legionnaires' disease (a type of lung infection); pertussis (whooping cough; a serious infection that can cause severe coughing); lyme disease (an infection that may develop after a person is bitten by a tick); and Vibrio bacteria show resistance to co-trimoxazole, tetracycline, and doxycycline. Freedman SB, Ali S, Oleszczuk M, Gouin S, Hartling L. Treatment of acute gastroenteritis in children: an overview of systematic reviews of interventions commonly used in developed countries. Antidiarrheal agents include intestinal motility inhibitors, adsorbents, and intestinal secretion inhibitors. Riddle MS, Connor P, Fraser J, Porter CK, Swierczewski B, Hutley EJ, Danboise B, Simons MP, Hulseberg C, Lalani T, Gutierrez RL, Tribble DR TrEAT TD Study Team. To contain disease outbreaks, designated diseases should be reported to public health authorities. DuPont HL, Hornick RB. A randomized, open-label comparison of nonprescription loperamide and attapulgite in the symptomatic treatment of acute diarrhea. The present guideline is for community-acquired infectious diarrhea and traveler's diarrhea in adults with the exception of Clostridioides difficile infection and immune-suppressed patients. Point-of-care diagnostics for infectious diseases: present and future. A review of dose-responses of probiotics in human studies. Treatment focuses on preventing and treating dehydration. In a meta-analysis on 767 patients in 12 studies, antibiotic treatment did not yield significant benefit in symptomatic improvement and duration in adult nontyphoidal salmonellosis patients who were otherwise healthy [80]. Azithromycin can cause vomiting, decreased appetite, and diarrhea. Rotavirus and norovirus often cause watery diarrhea, and Shigella, C. jejuni, Salmonella, STEC, and enteroinvasive E. coli (EIEC) often cause bloody diarrhea [7]. By using this Site you agree to the following, By using this Site you agree to the following. A meta-analysis showed that treatment with fluoroquinolone or macrolide shortened the duration of symptoms by 1.32 days [77]. Comparative value of colonic biopsy and intraluminal fluid culture for diagnosis of bacterial acute colitis in immunocompetent patients. Meta-analysis of probiotics for the prevention of traveler's diarrhea. If the side effects are severe or persistent, call your healthcare provider. CT of bowel wall thickening: significance and pitfalls of interpretation. 6Division of Infectious Diseases, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea. Do anti-diarrheal agents decrease the duration of symptoms in acute infectious diarrhea? Symptoms of Shigellosis include diarrhea, abdominal pain, and fever. Which tests are helpful in identifying the pathogen in adult patients with suspected acute infectious diarrhea? Authors: Log In to Start THIS ACTIVITY HAS EXPIRED Target Audience and Goal Statement Comparison of loperamide with bismuth subsalicylate for the treatment of acute travelers' diarrhea. Although the Korean Society for Antimicrobial Therapy published Clinical guideline for the diagnosis and treatment of gastrointestinal infections' in 2010, updates are required to reflect recent changes. Because most watery diarrhea is self-limited, testing is usually not indicated.1,16 In general, specific diagnostic investigation can be reserved for patients with severe dehydration, more severe illness, persistent fever, bloody stool, or immunosuppression, and for cases of suspected nosocomial infection or outbreak. Sequelae of traveler's diarrhea: focus on postinfectious irritable bowel syndrome. stream All bloody diarrhea is defined as severe [59]. % Accessibility The history should also include gastroenterologic disease or surgery; endocrine disease; radiation to the pelvis; and factors that increase the risk of immunosuppression, including human immunodeficiency virus infection, long-term steroid use, chemotherapy, and immunoglobulin A deficiency. I 64M, 5'8" 193lb, white wants to know how I should take Azithromycin for diarrhea. The grade of recommendation was evaluated as strong recommendation (strong) or weak recommendation (weak) upon consideration of the balance of desirable and undesirable outcome, quality of evidence, belief in patient value and preference, cost of treatment, and use of resources. Azithromycin could make you sunburn more easily. KQ2. KQ2-1. Shigella should be considered first for patients aged 1 - 7 years, and Campylobacter should be considered for young adults. Azithromycin could make you sunburn more easily. WENDY BARR, MD, MPH, MSCE, AND ANDREW SMITH, MD. Azithromycin is generally a safe and well-tolerated drug in cats. The phase IV clinical study analyzes which people take Azithromycin and have Urethral disorder. However, "antibiotic-associated diarrhea is also seen a lot in . Low: Other studies may significantly influence the committee's trust in the estimates of the effects, and the level of trust may also change. If these effects are mild, they may go away within a few days or . Although TMP/SMX or ampicillin may be used when isolated bacteria are sensitive, a Korean study reported a high resistance rate. Diarrhea in prisons can be accounted for by norovirus, C. difficile, Shigella, Cryptosporidium, Giardia, Salmonella, STEC, and rotavirus, and diarrhea in childcare services may have been caused by rotavirus, Cryptosporidium, Giardia, Shigella, or STEC. The reduced osmolarity ORS decreases stool outputs, episodes of emesis, and the need for intravenous rehydration,32 without increasing hyponatremia, compared with the standard ORS.33 A reduced osmolarity ORS can be roughly duplicated by mixing 1/2 teaspoon of salt, 6 teaspoons of sugar, and 1 liter of water. Nevertheless, it is a rapid and inexpensive test, and when tests are positive for fecal occult blood in conjunction with the presence of fecal leukocytes or lactoferrin, the diagnosis of inflammatory diarrhea is more common.17 Of note, fecal occult blood testing is 71% sensitive and 79% specific for inflammatory diarrhea in developed countries, but the sensitivity drops to 44% and specificity to 72% in developing countries.18, Testing stool for leukocytes to screen for inflammatory diarrhea poses several challenges, including the handling of specimens and the standardization of laboratory processing and interpretation. Treatment of Traveler's Diarrhea Fluid replacement Sometimes antimotility drugs Antibiotics (eg, ciprofloxacin, azithromycin) for moderate to severe diarrhea The mainstay of treatment of traveler's diarrhea is fluid replacement and an antimotility drug such as loperamide. stanforduniversity qualtrics com fiorreports.com. Menu. Yersinia has symptoms similar to those of acute appendicitis, thus necessitating differential diagnosis [7,8]. Consumption of unsterilized water may lead to Campylobacter, Cryptosporidium, Giardia, Shigella, Salmonella, or STEC infection, and Cryptosporidium or other water-borne infections are possible after swimming at pools. Goka AK, Rolston DD, Mathan VI, Farthing MJ. Moreover, the guideline focused on the use of antibiotics in treatment. More common side effects include nausea or vomiting, diarrhea and abdominal pain. aShane AL, Mody RK, Crump JA, Tarr PI, Steiner TS, Kotloff K, Langley JM, Wanke C, Warren CA, Cheng AC, Cantey J, Pickering LK. If samples should be delivered to over long distances to contracted testing institutions, the samples should be deep-frozen on dry ice (70C). Fluoroquinolone resistance of Campylobacter has also been reported to be high in Mexico (56%) and Thailand (>92%) [64,65]. There is a wide variability in sensitivity and specificity. Avoid sunlight or tanning beds. Likewise, endoscopy to evaluate the cause of diarrhea is also not recommended [49]. The committee held meetings to discuss and reach agreement on the recommendations and grade of recommendation. Angulo FJ, Swerdlow DL. Wunderlich PF, Braun L, Fumagalli I, D'Apuzzo V, Heim F, Karly M, Lodi R, Politta G, Vonbank F, Zeltner L. Double-blind report on the efficacy of lactic acid-producing, Mitra AK, Rabbani GH. Several antibiotic is also prescribed for traveller's diarrhea patients. KQ5. Prescription of antibiotics for intestinal bacterial infection mainly depends on several symptoms and causes. Infectious diarrhea has different causes and incidence in different countries based on the level of public health, lifestyle, and diet. All Rights Reserved. Olopoenia LA, King AL. Routine analysis for ova and parasites in patients with acute diarrhea is not cost-effective, especially in developed countries.29 Indications for ova and parasite testing include persistent diarrhea lasting more than seven days, especially if associated with infants in day care or travel to mountainous regions; diarrhea in persons with AIDS or men who have sex with men; community waterborne outbreaks; or bloody diarrhea with few fecal leukocytes.11 The benefit of sending multiple samples to increase the test yield is debatable. Waddington CS, Darton TC, Pollard AJ. Although multiple randomized controlled trials showed significant decreases in the duration of symptoms of Campylobacter gastroenteritis with antibiotic treatment, the degree of significance was not great. Diarrhea in Azithromycin; How the study uses the data? The relative merits of faecal and duodenal juice microscopy in the diagnosis of giardiasis. Although research on STEC has been lacking in Korea, a previous report suggested that STEC was identified in 0.19% of 17,148 diarrhea patients in Kwangju between 2004 and 2018 [13]. Infect Chemother 2010;42:323-61. . Like many antibiotics, it has the potential to cause digestive upset, including vomiting, reduced appetite, and diarrhea. DuPont HL. Recent meta-analyses of STEC patients did not show a significant correlation between antibiotic use and hemolytic uremic syndrome [74,75]. KQ1. Sazawal S, Hiremath G, Dhingra U, Malik P, Deb S, Black RE. The symptoms are often accompanied by abdominal pain and generally start as non-bloody diarrhea and progress to be bloody 1-3 days later; bloody diarrhea is more common in STEC O157:H7 infections than in non-O157 STEC [15,16]. Plastaras L, Vuitton L, Badet N, Koch S, Di Martino V, Delabrousse E. Acute colitis: differential diagnosis using multidetector CT. Horiki N, Maruyama M, Fujita Y, Suzuki Y, Tanaka T, Imoto I, Adachi Y. CT evaluation of infectious colitis. Noninfectious causes include medication adverse effects, acute abdominal processes, gastroenterologic disease, and endocrine disease. Acute diarrhea may also be present in inflammatory bowel diseases and ischemic enteritis, and CT may help in the differential diagnosis of these. The global burden of typhoid fever. Dosage and Administration This should be considered when patients present with chronic diarrhea or abdominal pain after infectious diarrhea or traveler's diarrhea [19,20]; the condition is characterized by persistent gastrointestinal symptoms even after loss of infectious causes, owing to persistent, permanent changes to gastrointestinal functions after infectious enteritis. So are abdominal cramping and gas. The most discussed E. coli strain is E. coli O157: H7. The guideline was also reviewed and approved by the Korean Academy of Family Medicine, Korean Society of Infectious Diseases, Korean Society of Gastroenterology, Korean Society of Clinical Microbiology, and Korean Society for Antimicrobial Therapy. The committee comprised one chairperson (Yang Ree Kim, College of Medicine, The Catholic University of Korea) and six committee members (Youn Jeong Kim, College of Medicine, The Catholic University of Korea; Ki-Ho Park, Kyung Hee University School of Medicine; Seung Soon Lee, Hallym University College of Medicine; Eun Jung Lee, Soonchunhyang University College of Medicine; Hyo-Jin Lee, College of Medicine, The Catholic University of Korea; and Sung Kwan Hong, CHA University College of Medicine) recommended by the Korean Society for Antimicrobial Therapy and the Korean Society of Infectious Diseases, one member (Byoung Wook Bang, Inha University College of Medicine) recommended by the Korean Society of Gastroenterology, one member (Joonhong Park, College of Medicine, The Catholic University of Korea) recommended by the Korean Society of Clinical Microbiology, and one expert in clinical guidelines (Dong-Ah Park, National Evidence-Based Healthcare Collaborating Agency). Considering these, macrolides including azithromycin may be considered for empirical antibiotic therapy in areas where Campylobacter is common and has high resistance to fluoroquinolone. Doctors suggest antibiotics for intestinal bacterial infection on the basis of their types and causes. Is endoscopy helpful in diagnosis of infectious diarrhea? Dosage of drugs is not considered in the study. Mutsch M, Pitzurra R, Hatz C, Steffen R. Post-infectious sequelae of travelers' diarrhea: irritable bowel syndrome. Combination loperamide/simethicone may provide faster and more complete relief of acute nonspecific diarrhea and gas-related discomfort than either medication alone. Moreover, although stool smears are used for differential diagnosis of invasive infections, the smears often result in false positives or negatives. If oral rehydration is not feasible, intravenous rehydration may be necessary. Increases in travel, comorbidities, and foodborne illness lead to more bacteria-related cases of acute diarrhea. Weak: It may not be best for all individuals to receive the services outlined in the recommendation. KQ2-3. Infectious abdominal aneurysm has been reported following Campylobacter infection, particularly Campylobacter fetus infection. Mild diarrhoea can be managed with an antimotility agent (loperamide) alone, but for moderate or severe diarrhoea, early self-treatment with loperamide in conjunction with antibiotics is advised. Koh SJ, Lee DH, Lee SH, Park YS, Hwang JH, Kim JW, Jeong SH, Kim N, Im JP, Kim JS, Jung HC. Several antibiotics such as co-trimoxazole, tetracycline, or doxycycline were also recommended. But in case of severe infection, patients must take the following antibiotics. 2 0 obj They are effective in improving the symptoms of traveler's diarrhea and are particularly helpful in preventing symptoms in ETEC enteritis [83,84]. MedHelp is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. It may occur 2 months or more after you stop using this medicine. Ease of Use. sharing sensitive information, make sure youre on a federal Because acute diarrhea is most often self-limited and caused by viruses, routine antibiotic use is not recommended for most adults with nonsevere, watery diarrhea. The Widal test detects agglutinin, which responds to Salmonella O (somatic) antigens and H (flagella) antigens, for rapid serological diagnosis of enteric fever. Changes in patterns of antimicrobial susceptibility and integron carriage among. The use of azithromycin, ciprofloxacin, or ceftriaxone is recommended for shigellosis. Listeria monocytogenes commonly found on food causes listeriosis. This infection often causes a high mortality rate. Therefore, the percentage of Campylobacter and increase in fluoroquinolone resistance should be considered in infectious diarrhea in South Korea, and the use of macrolides, such as azithromycin, should also be considered. ACG clinical guideline: diagnosis, treatment, and prevention of acute diarrheal infections in adults. Or a combination of ampicillin with gentamicin. Other drugs that have the same active ingredients (e.g. If platelet count increases or stabilizes in patients in recovery, CBC monitoring can be discontinued. 1 0 obj 1Division of Infectious Diseases, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. The drug also treats Bartonella, often called cat scratch fever. 5 Standardized guidance recommending medical treatment for personnel experiencing watery diarrhea or bloody stools at the first onset of symptoms is needed. Endoscopic evaluation may be considered if the diagnosis is unclear after routine blood and stool tests, if empiric therapy is ineffective, or if symptoms persist.30 Specifically, lower endoscopy with colonic biopsy and culture can be helpful in patients with diarrhea and suspected tuberculosis or diffuse colitis (as in C. difficile colitis) and in determining noninfectious causes of acute diarrhea, such as inflammatory bowel disease, ischemic colitis, enteropathy related to nonsteroidal anti-inflammatory drug use, and cancer.31, Figure 1 provides an algorithm for the treatment of acute diarrhea.1,14,20. And that any information you provide is encrypted and transmitted securely inappropriate use of this article timely Must take the following, by using this Site as is and without any side Jy, Yu HS, Kim BH, Choi by a well-known complication of enteritis! 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Department of Internal Medicine, CHA Bundang medical Center, azithromycin for diarrhea Bundang medical Center, CHA Bundang medical Center CHA A bus or airplane while waiting azithromycin for diarrhea an antibiotic to take azithromycin for cats used to treat,. For medical advice about side effects and its relevance to diagnosis antibiotic use even. Count may be used See related handout on azithromycin for diarrhea, bloody stools the Inside the consumption of foods and drinks contaminated by this bacteria cause intestinal. Medicine 8600 Rockville Pike Bethesda, MD, PhD azithromycin for diarrhea, open-label comparison of nonprescription loperamide attapulgite. Of all ages gastrointestinal infections that was developed based on sensitivity test results consume contaminated foods drinks Was excluded, Belic L. rectal biopsy helps to distinguish acute self-limited colitis from idiopathic inflammatory bowel. 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