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Abstract
Background/Aims
Recurrence of ischemic colitis (IC) has not been studied extensively. The aim of this study was to investigate the characteristics of recurrent IC in the community setting and to identify any risk factors.
Methods
We conducted a retrospective study in two community hospitals. Medical records of patients with IC from January 2007 to January 2013 were reviewed. Demographic details, clinical features, co-morbidities, concomitant use of medications, laboratory studies, imaging findings, endoscopic and histological features, surgery, hospital stay, and death within 30 days were collected. Patients were divided into two groups (recurrent IC group, non-recurrent IC group).
Results
A total of 118 patients with IC were identified. IC recurred in 10 patients (8.5%) during the study period. Half of the patients in the recurrent IC group were current smokers as compared to only 18.7% of patients in the non-recurrent group. In the recurrent IC group, 20.0% of patients never smoked as compared to 61.7% in the non-recurrent group (p=0.027). Abdominal aortic aneurysm (AAA) was more frequent in the recurrent IC group (40.0% vs. 4.7%; p=0.003). No differences in other clinical symptoms, CT scan findings, comorbidities, endoscopic features, or use of concomitant medications were observed between the two groups. The need for surgical intervention, blood transfusion, intensive care unit stay, mechanical ventilation, length of hospital stay, and anatomic location of affected segments did not differ between the two groups.
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Table 1.
Clinical Characteristics of the Two Groups
| Variable | Recurrent ischemic colitis group (n=10) | Non-recurrent ischemic colitis group (n=108) | p-value | Variable | Recurrent ischemic colitis group (n=10) | Non-recurrent ischemic colitis group (n=108) | p-value |
|---|---|---|---|---|---|---|---|
| Age (yr) | 71.50±13.02 | 69.21±15.28 | 0.724 | Abdominal surgery (any) | 8 (80.0) | 58 (54.7) | 0.184 |
| Gender | 1.000 | Appendectomy | 3 (30.0) | 19 (17.9) | 0.398 | ||
| Female | 9 (90.0) | 89 (82.4) | Cholecystectomy | 4 (40.0) | 25 (23.6) | 0.265 | |
| Male | 1 (10.0) | 19 (17.6) | Hysterectomy | 5 (50.0) | 31 (29.3) | 0.281 | |
| Race group | 0.689 | Missing data | 0 | 2 | |||
| White | 9 (90.0) | 88 (81.5) | Drugs | ||||
| Others | 1 (10.0) | 20 (18.5) | Clopidogrel | 3 (30.0) | 21 (19.8) | 0.429 | |
| BMI | 25.58±2.93 | 28.30±6.81 | 0.269 | Aspirin | 5 (50.0) | 48 (45.3) | 1.000 |
| Smokinga | 0.027 | Statins | 3 (30.0) | 50 (47.20 | 0.341 | ||
| Never smoked | 2 (20.0) | 66 (61.7) | Calcium channel | 6 (60.0) | 33 (31.1) | 0.084 | |
| Ex-smoker | 3 (30.0) | 21 (19.6) | blockers | ||||
| Current smoker | 5 (50.0) | 20 (18.7) | B-blockers | 5 (50.0) | 51 (48.1) | 1.000 | |
| Missing data | 0 | 1 | ACEIs | 4 (40.0) | 50 (47.2) | 0.749 | |
| Clinical symptoms/signs | ARBs | 0 (0.0) | 13 (12.3) | 0.600 | |||
| Abdominal pain | 8 (80.0) | 89 (82.4) | 1.000 | Diuretics | 2 (20.0) | 32 (30.2) | 0.721 |
| Nausea | 5 (50.0) | 38 (35.2) | 0.494 | NSAIDs | 0 (0.0) | 11 (10.4) | 0.595 |
| Vomiting | 3 (30.0) | 31 (28.7) | 1.000 | Digoxin | 0 (0.0) | 6 (5.7) | 1.000 |
| Diarrhea | 6 (60.0) | 59 (54.6) | 1.000 | Warfarin | 0 (0.0) | 14 (13.2) | 0.607 |
| Rectal bleeding | 6 (60.0) | 82 (75.9) | 0.273 | Antidepressants/ | 3 (30.0) | 31 (29.3) | 1.000 |
| Abdominal distension | 1 (10.0) | 7 (6.5) | 0.519 | antipsychotics | |||
| Fever | 1 (10.0) | 17 (15.7) | 1.000 | Missing data | 0 | 2 | |
| Peritoneal signs | 0 (0.0) | 6 (5.6) | 1.000 | Hospital stay (day) | 7.00±8.23 | 6.64±7.60 | 0.855 |
| SBP | 127.50±12.87 | 135.78±34.48 | 0.288 | ICU stay (%) | 1 (10.0) | 22 (20.4) | 0.688 |
| DBPa | 62.10±10.42 | 71.31±15.89 | 0.029 | Mechanical ventilation | 1 (10.0) | 13 (12.0) | 1.000 |
| HR | 73.60±13.45 | 84.37±21.96 | 0.087 | IC occurrence during | 0 (0.0) | 11 (10.2) | 0.598 |
| Comorbidities | hospitalization | ||||||
| Hypertension | 8 (80.0) | 85 (79.4) | 1.000 | Blood transfusion | 2 (20.0) | 22 (20.4) | 1.000 |
| Hyperlipidemia | 6 (60.0) | 62 (57.9) | 1.000 | Surgery | 1 (10.0) | 13 (12.0) | 1.000 |
| CAD | 4 (40.0) | 33 (30.8) | 0.723 | Death in 30 days | 1 (10.0) | 4 (3.7) | 0.363 |
| Diabetes mellitus | 1 (10.0) | 24 (22.4) | 0.687 | Severe ischemic colitis | 1 (10.0) | 14 (13.0) | 1.000 |
| CHF | 2 (20.0) | 8 (7.5) | 0.204 | (required surgery or died) | |||
| Atrial fibrillation | 2 (20.0) | 19 (17.8) | 1.000 | Direct causes | |||
| PVD | 2 (20.0) | 9 (8.4) | 0.238 | Constipation | 2 (20.0) | 14 (13.0) | 0.625 |
| Cerebrovascular disease | 2 (20.0) | 11 (10.3) | 0.307 | Hypotension | 0 (0.0) | 7 (6.5) | |
| COPD | 1 (10.0) | 16 (15) | 1.000 | Drug/vasculitis | 0 (0.0) | 6 (5.6) | |
| CKD | 3 (30.0) | 12 (11.2) | 0.118 | ||||
| DVT | 0 (0.0) | 4 (3.7) | 1.000 | ||||
| IBS | 0 (0.0) | 3 (2.8) | 1.000 | ||||
| AAAa | 4 (40.0) | 5 (4.7) | 0.003 | ||||
| Missing data | 0 | 1 |
Values are presented as mean±SD, n (%), or n only.
SBP, systolic blood pressure; DBP, diastolic blood pressure; HR, heart rate; CAD, coronary artery disease; CHF, congestive heart failure; PVD, peripheral vascular disease; COPD, chronic obstructive pulmonary disease; CKD, chronic kidney disease; DVT, deep venous thrombosis; IBS, irritable bowel syndrome; AAA, abdominal aortic aneurysm; ACEIs, angiotensin converting enzyme inhibitors; ARBs, angiotensin receptor blockers; ICU, intensive care unit; IC, ischemic colitis.
Table 2.
Age Distribution in the Two Groups
Table 3.
Laboratory, Radiology, Colonoscopy, and Histopathology Findings between the Two Groups
| Variable | Recurrent ischemic colitis (n=10) | Non-recurrent ischemic colitis (n=108) | p-value |
|---|---|---|---|
| White blood cells (×103/mL) | 12.91±5.89 | 12.96±6.29 | 0.919 |
| Hemoglobin (g/dL) | 13.10±1.26 | 13.04±1.95 | 0.904 |
| Albumin (g/dL) | 3.59±0.38 | 3.63±0.55 | 0.634 |
| Bicarbonate (mEq/L) | 26.10±3.07 | 25.25±3.76 | 0.471 |
| Sodium (mEq/L) | 135.80±3.77 | 137.33±14.36 | 0.062 |
| Creatinine (mg/dL) | 1.88±1.64 | 1.33±0.82 | 0.541 |
| ALTa (IU/L) | 20.30±9.02 | 30.86±17.14 | 0.025 |
| Amylase (IU/L) | 58.83±27.79 | 109.37±180.98 | 0.634 |
| Lipase (IU/L) | 91.22±116.0 | 122.63±117.34 | 0.167 |
| Glucose (mg/dL) | 116.50±17.58 | 137.78±73.96 | 0.252 |
| Lactic acid (mmol/L) | 1.10±0.10 | 4.95±12.33 | 0.090 |
| CT scan | |||
| Performed | 9 (90.0) | 81 (75.0) | |
| Normal CT | 1 (11.1) | 9 (11.1) | 1.000 |
| Wall thickening | 7 (77.8) | 58 (71.6) | 0.716 |
| Induration | 1 (11.1) | 19 (23.5) | 0.677 |
| Pericolonic fat stranding | 6 (66.7) | 48 (59.3) | 0.736 |
| Loss of haustrae | 1 (11.1) | 4 (4.9) | 0.417 |
| Free intraabdominal fluid | 1 (11.1) | 15 (18.5) | 1.000 |
| Pneumatosis coli | 0 (0.0) | 7 (8.6) | 1.000 |
| Portal/mesenteric venous gas | 0 (0.0) | 4 (4.9) | 1.000 |
| Pneumoperitoneum | 0 (0.0) | 4 (4.9) | 1.000 |
| Bowel dilation | 1 (11.1) | 12 (14.8) | 1.000 |
| Colonoscopy findings | |||
| Performed | 8 (80.0) | 81 (75.0) | |
| Edematous mucosa | 5 (62.5) | 47 (58.8) | 1.00 |
| Erythema | 5 (62.5) | 52 (65.0) | 1.001.00 |
| Erosions/ulcerations | 5 (62.5) | 42 (52.5) | 1.000.719 |
| Friability/active bleeding | 2 (25.0) | 22 (27.5) | 0.7191.00 |
| Exudate/necrosis | 0 (0.0) | 9 (11.3) | 1.001.00 |
| Stricture | 0 (0.0) | 2 (2.5) | 1.001.00 |
| Missing data | 0 | 1 | 1.00 |
| Histology findings | |||
| Available | 7 (70.0) | 87 (80.6) | |
| Normal histology | 0 (0.0) | 4 (4.6) | 1.00 |
| Edema | 1 (14.3) | 7 (8.1) | 0.475 |
| Epithelium loss/ulceration | 1 (14.3) | 30 (34.5) | 0.419 |
| Crypt loss | 0 (0.0) | 8 (9.2) | 1.00 |
| Acute inflammation | 6 (85.7) | 62 (71.3) | 0.669 |
| Chronic inflammation | 2 (28.6) | 31 (35.6) | 1.00 |
| Capillary thrombosis | 0 (0.0) | 5 (5.8) | 1.00 |
| Necrosis/exudatea | 0 (0.0) | 39 (44.8) | 0.039 |
| Submucosal hemorrhage | 1 (14.3) | 19 (21.8) | 1.00 |
| Vascular congestion | 0 (0.0) | 5 (5.8) | 1.00 |
| Mucosal/transmural infarct | 0 (0.0) | 7 (8.1) | 1.00 |
| Chronic ulcer | 1 (14.3) | 8 (9.3) | 0.522 |
| Location | |||
| Left colon | 8 (80.0) | 88 (85.4) | 1.00 |
| Right colon | 2 (20.0) | 15 (14.6) | 0.647 |
| Pancolitis | 0 (0.0) | 1 (1.0) | 1.00 |
| Rectum | 0 (0.0) | 4 (3.9) | 1.00 |
| Rectosigmoid junction | 1 (10.0) | 14 (13.6) | 1.00 |
| Sigmoid colon | 6 (60.0) | 44 (42.7) | 0.337 |
| Descending colon | 8 (80.0) | 66 (64.1) | 0.490 |
| Splenic flexure | 4 (40.0) | 55 (53.4) | 0.513 |
| Transverse colon | 4 (40.0) | 30 (29.1) | 0.488 |
| Hepatic flexure | 0 (0.0) | 9 (8.7) | 1.00 |
| Ascending colon | 1 (10.0) | 13 (12.6) | 1.00 |
| Cecum | 2 (20.0) | 11 (10.7) | 0.327 |
| Missing data | 0 | 6 |
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