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Non-CDI Antibiotic-Associated Stoma Diarrhoea — SCE Palliative Medicine MCQ

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EasyGI SymptomsNon-CDI Antibiotic-Associated Stoma DiarrhoeaSCE Palliative Medicine

A 72‑year‑old woman with advanced bowel cancer and a permanent end colostomy develops profuse watery stoma output (high‑output stoma) shortly after completing a course of broad‑spectrum antibiotics. C. difficile testing is negative. What is the most likely diagnosis?

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Correct answer: B — Antibiotic‑associated diarrhoea (non‑C

Non‑C. difficile antibiotic‑associated diarrhoea is the most common form of AAD (70–80%), arising from disruption of normal colonic flora leading to osmotic and sometimes secretory diarrhoea. The temporal antibiotic history plus negative C. difficile exclusion makes this diagnosis clear. Stoma ischaemia would present acutely with pain, erythema or necrosis. Bile acid malabsorption typically causes chronic diarrhoea without acute onset post‑antibiotics and occurs in small bowel resection contexts. Crohn’s flare would show inflammation/systemic signs and require prior diagnosis. Radiation enteritis relies on history of recent radiotherapy. Management in UK practice includes antidiarrhoeal such as loperamide even off‑label for high stoma output.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/cancer/palliative-care