Abstract
Background/Aims
Ischemic colitis (IC) usually occurs in the elderly population and has a various clinical presentations from mild to severe forms. The aim of this study was to investigate the clinical outcomes according to the involved sites and colonoscopic findings in IC.
Methods
We retrospectively analyzed the medical records of 77 patients who had diagnosed with IC between January 2000 and July 2010. The clinical outcomes were compared according to numbers of the involved segments, location and endoscopic findings.
Results
Mean age of the patients was 70±11 years and male to female ratio was 1:1.26. Hematochezia (67.5%) and abdominal pain (63.6%) were the most common associated symptoms. The colonoscopic examination was performed at mean 4.6±3.7 days after the symptom onset. The most common involved segment was the sigmoid colon (72.7%). Duration of fasting, antibiotics therapy, hospital stay and mortality were significantly increased in the patients group with more involved segments (p<0.001, p=0.004, p<0.001, p<0.001, respectively). Duration of antibiotics therapy and hospital stay were significantly longer in the right colon involvement group (p=0.038, p=0.002, respectively). The time taken until the alleviation of symptoms and the white blood cells count were significantly longer and higher in the ulcer or gangrenous group (p=0.001, p=0.022, respectively).
Conclusions
Evaluating the involved sites, the degree and severity of mucosal damage by colonoscopy may be important in predicting the clinical course and prognosis of the patients with IC. Early detection, careful monitoring and prompt treatment are crucial especially in the patients with ulcer or necrosis in colonscopic findings.
References
1. Zou X, Cao J, Yao Y, Liu W, Chen L. Endoscopic findings and clinicopathologic characteristics of ischemic colitis: a report of 85 cases. Dig Dis Sci. 2009. 54:2009–2015.
2. Añón R, Boscá MM, Sanchiz V, et al. Factors predicting poor prognosis in ischemic colitis. World J Gastroenterol. 2006. 12:4875–4878.
3. Brandt LJ, Feuerstadt P, Blaszka MC. Anatomic patterns, patient characteristics, and clinical outcomes in ischemic colitis: a study of 313 cases supported by histology. Am J Gastroenterol. 2010. 105:2245–2252.
4. Green BT, Tendler DA. Ischemic colitis: a clinical review. South Med J. 2005. 98:217–222.
5. Jung SH, Lee KM, Ji JS, et al. Clinical features and prognostic factors in ischemic colitis. Korean J Gastrointest Endosc. 2008. 36:349–353.
6. Scharff JR, Longo WE, Vartanian SM, Jacobs DL, Bahadursingh AN, Kaminski DL. Ischemic colitis: spectrum of disease and outcome. Surgery. 2003. 134:624–629.
7. Theodoropoulou A, Koutroubakis IE. Ischemic colitis: clinical practice in diagnosis and treatment. World J Gastroenterol. 2008. 14:7302–7308.
8. Weil J, Sen Gupta R, Herfarth H. Nonocclusive mesenteric ischemia induced by digitalis. Int J Colorectal Dis. 2004. 19:277–280.
9. Brandt LJ, Boley SJ. Colonic ischemia. Surg Clin North Am. 1992. 72:203–229.
10. Barouk J, Gournay J, Bernard P, Masliah C, Le Neel JC, Galmiche JP. Ischemic colitic in the elderly: predictive factors of gangrenous outcome. Gastroenterol Clin Biol. 1999. 23:470–474.
11. Sotiriadis J, Brandt LJ, Behin DS, Southern WN. Ischemic colitis has a worse prognosis when isolated to the right side of the colon. Am J Gastroenterol. 2007. 102:2247–2252.
12. Ryu KH, Shim KN, Jung SA, et al. Clinical features of ischemic colitis: a comparision with colonoscopic findings. Korean J Gastrointest Endosc. 2006. 33:145–151.
13. Longo WE, Ward D, Vernava AM 3rd, Kaminski DL. Outcome of patients with total colonic ischemia. Dis Colon Rectum. 1997. 40:1448–1454.
14. Matsumoto S, Tsuji K, Shirahama S. Clinical investigation of 41 patients with ischemic colitis accompanied by ulcer. World J Gastroenterol. 2007. 13:1236–1239.
15. Medina C, Vilaseca J, Videla S, Fabra R, Armengol-Miro JR, Malagelada JR. Outcome of patients with ischemic colitis: review of fifty-three cases. Dis Colon Rectum. 2004. 47:180–184.
16. Lim YJ, Son HJ, Kang TW, et al. Clinical patterns and prognostic factors of ischemic colitis. Korean J Gastrointest Endosc. 2001. 22:76–82.