Enterocolitis is an inflammation that includes the small intestine and large intestine. A form of enterocolitis is called pseudomembraneous enteritis or colitis. This starts as an acute inflammation, and may evolve into a condition of long duration. The colonic membrane is covered with an adherent plaque that overlies areas of superficial ulceration. Another name for this condition is necrotizing enteritis.

The most overwhelming causative factor in the development of this condition is the use of certain antibiotics that alter the intestinal flora. Clostridium difficile colonizes in the large intestine causing diarrhea. Other factors include age, reduced gastric acidity from medications, and an immune deficiency such as acquired immunodeficiency syndrome (AIDS).

The symptom of diarrhea, which may become bloody, starts during or after oral or parenteral antibiotic therapy. Symptoms may last for 2 to 3 weeks, and leukocytosis and fever may be present. Psedomembraneous material may be passed in the stool. Development of electrolyte imbalance, hypoproteinemia, and toxic dilatation of the colon may occur in severe cases.

Examinations used to obtain a diagnosis may include a stool test for specific colon toxins. Enzyme immunoassays are also performed for the detection of these toxins. A sigmoidoscopy and mucosa biopsy will confirm the presence of the pseudomembrane. An abdominal x-ray may demonstrate increased intestinal wall thickness and mucosal irregularities.

If possible, the antibiotic therapy should be discontinued, and mild symptoms may recede. When symptoms are persistent or are severe and therapy is still required, then two specific anti-infective drugs that are most effective in treating clostridium difficile are used. This drug therapy should bring about improvement in 10 days. If necessary, these drugs can be given via nasogastric tube when the oral route cannot be used. In severe cases, when use of one drug does not bring about sufficient concentration, then a second drug will be added. In some situations, an emergency colectomy for toxic dilatation is necessary.

Relapse is a common occurrence 4 weeks after therapy is discontinued. These relapses are more often in the elderly or those who have had abdominal surgery. A full course of treatment is readministered.

• None.

• Rate as Irritable Bowel Syndrome (DC 7319) or Crohn's disease or undifferentiated form of inflammatory bowel disease (DC 7326), depending on the predominant disability.

• Ratings under diagnostic codes 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348 inclusive will not be combined with each other. A single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation.[38 CR 4.114]

• There are diseases of the digestive system, particularly within the abdomen, which, while differing in the site of pathology, produce a common disability picture characterized in the main by varying degrees of abdominal distress or pain, anemia and disturbances in nutrition. Consequently, certain coexisting diseases in this area, as indicated in the instruction under the title “Diseases of the Digestive System,” do not lend themselves to distinct and separate disability evaluations without violating the fundamental principle relating to pyramiding as outlined in 38 CFR 4.14.  [38 CFR 4.113]