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Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.

In olden days we used to teach that if the patient is passing blood and mucus in the stools, the causes could be :

1. Amoebic dysentery

2. Bacillary dysentery

Although, the dysentery word is used by public for passing mucus in the stools and since irritable bowel syndrome is a common cause of that complaint, presence of blood in the stools in addition to mucus gains too much importance in the history taking. However, for last few years I have not seen a case of amoebic or bacillary dysentery.

These days I suggest that family physicians should diagnose the following two causes of bloody dysentery specially if the patient has received metronidazole.

1. Ulcerative colitis

2. Pseudo-membranous colitis

The former can be confirmed very easily by doing sigmoidoscopy or colonic biopsy. The latter is invariably seen in indoor hospital patients who have been prescribed a number of antibiotics. They respond if antibiotics are omitted and a course of vancomycin and metronidazole is given. The culprits in these cases are claustridia doficile bacilli.

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