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Heo, Kim, Song, Park, Park, and Moon: Characteristics of Clinical Features between Isolated Left Side Ischemic Colitis and Non-Isolated Left Side Ischemic Colitis
Original Article

Kosin Medical Journal 2013;28(2):99-106.

Published online: 19 January 2013

DOI: https://doi.org/10.7180/kmj.2013.28.2.99

Characteristics of Clinical Features between Isolated Left Side Ischemic Colitis and Non-Isolated Left Side Ischemic Colitis

Jae Joon Heo1, Hyung Hun Kim2, Jun Young Song1, Seun Ja Park1, Moo In Park1, Won Moon1

1Department of Internal Medicine, College of Medicine, Kosin University, Busan, Korea

2Department of Internal Medicine, College of Medicine, Catholic University, Seoul, Korea

Corresponding author: Hyung Hun Kim, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 137-701, Korea TEL: +82-2-2258-2038 FAX: +82-2-2258-2039 E-mail: drhhkim@gmail.com

Received 7 March 20131 May 2013       Accepted 26 June 2013

Copyright © 2013 Kosin University School of Medicine Proceedings

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

Compared with all other patterns, isolated right colon ischemia has been found to be more associated with coronary artery disease and a poor prognosis. However, there has been no research on comparing isolated left side ischemic colitis (ILIC) and non-ILIC with vascular assessment. The aim of the present study was to evaluate the clinical and laboratory findings between these two different forms of ischemic colitis (IC).

Methods

We retrospectively investigated differences in clinical features, course, and mesenteric vascular (superior mesenteric artery, SMA; inferior mesenteric artery, IMA) findings between ILIC and non-ILIC patients who were hospitalized at Kosin University Gospel Hospital from 2004 to 2010.

Results

Our study population comprised 221 patients, all of whom met our entry criteria of biopsy-proven or -compatible IC. Of the 221 patients, 46 (20.8%) had non-ILIC. Congestive heart failure and hypercholesterolemia were more frequently observed in the non-ILIC group (P = 0.003 and P = 0.020, respectively). SMA atherosclerosis and SMA stenosis were more frequently observed in the non-ILIC group (P = 0.006 and P = 0.001, respectively). Recovery periods were longer in the non-ILIC group (P = 0.039), and mortality was lower in the ILIC group (6.9% vs. 17.3%, P = 0.026).

Conclusions

ILIC has favorable outcomes compared with non-ILIC. Furthermore, non-ILIC showed a close relationship with SMA atherosclerosis and SMA stenosis, which should be investigated carefully in the clinical field.

Keywords: Atherosclerosis, Ischemic colitis, Stenosis, Superior mesenteric artery

REFERENCES

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Fig. 1.
Severity of ischemic colitis assessed by colonoscopy. (A) Mild ischemic colitis is defined as segmental hyperemic erosive mucosal change without deep ulceration. (B) Moderate ischemic colitis is defined as hyperemic mucosal change and focal ulceration with severe edema. (C) Severe ischemic colitis is defined as extensive exfoliation of colonic mucosa combined with deep ulceration or gangrene.
kmj-28-99f1.tif
Fig. 2.
Kaplan–Meier survival curve comparing ILIC with non-ILIC. Mortality is lower in the ILIC group than non-ILIC group (6.9% vs. 17.3%, P = 0.026, hazard ratio = 0.286, 95% confidence interval = 0.095-0.855). ILIC, isolated left side ischemic colitis.
kmj-28-99f2.tif
Table 1.
Baseline characteristics of patients in two groups at symptomonset
Non-ILIC n = 46 ILIC n = 175 P-Value
Age, year, mean ± SD 66.5 ± 11.9 64.0 ± 12.4 0.656
Sex, male, n (%) 17 (36.9) 71 (40.6) 0.224
Recent operation, n (%) 0 (0.0) 9. (5.1) 0.210
ECOG performance status 0.124
Score 1, n (%) 2 (4.3) 20 (11.4)
Score 2, n (%) 11 (24.0) 36 (20.6)
Score 3, n (%) 23 (50.0) 62 (35.4)
Score 4, n (%) 10 (21.7) 58 (32.6)
Laboratory findings
Albuming, g/dL, mean ± SD 3.1 ± 0.7 3.9 ± 2.8 0.058
Total protein, g/dL, mean ± SD 5.8 ± 0.9 6.5 ± 0.8 < 0.001*
Total cholesterol, mg/dL, mean ± SD 143.2 ± 61.5 109.3 ± 63.0 0.001**
Triglyceride, mg/dL, mean ± SD 81.2 ± 60.9 78.7 ± 46.2 0.102
Hgb, g/dL, mean ± SD 12.2 ± 2.2 12.9 ± 2.1 0.216
WBC, counts/dL, mean ± SD 13,145.1 ± 6,702.2 11,828.3 ± 63,265 0.052
CRP, mg/dL, mean ± SD 7.7 ± 7.7 5.1 ± 7.1 0.049***
ESR, mg/dL, mean ± SD 22.3 ± 21.2 32.8 ± 37.0 0.066

ILIC, isolated left side ischemic colitis; Non-ILIC, non isolated left side ischemic colitis; ECOG, eastem cooperative oncology group; Hgb, hemoglobin; WBC, white blood cell; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate.

Table 2.
Medical comorbidities in the tow groups
Non-ILIC n = 46 ILIC n = 175 P-Value
Cardiovascular disease
Hypertension, n (%) 19 (41.3) 82 (46.9) 0.512
Ischemic heart disease, n (%) 7 (15.2) 24 (13.7) 0.794
Atrial fibrillation, n (%) 18 (39.1) 69 (39.4) 0.971
Congestive heart failure, n (%) 8 (17.4) 8 (4.6) 0.003*
Cerebrovascular accident, n (%) 10 (21.7) 23 (13.1) 0.164
Diabetes mellitus, n (%) 16 (34.8) 47 (26.9) 0.359
Peripheral vascular disease, n (%) 2 (4.3) 6 (3.4) 0.673
Autoimmune disease, n (%) 2 (4.3) 8 (4.6) 1.000
Hypercholesterolemia, n (%) 9 (19.5) 12 (6.9) 0.020**
Chronic renal insufficiency, n (%) 4 (8.7) 11 (6.3) 0.522
Chronic obstructive pulmonary disease, n (%) 7 (15.2) 15 (8.5) 0.180
Hyperthyroidism, n (%) 1 (2.2) 3 (1.7) 1.000
Hypothyroidism, n (%) 2 (4.3) 6 (3.4) 0.673

ILIC, isolated left side ischemic colitis; Non-ILIC, non isolated left side ischemic colitis.

* Odds ratio = 4.395, 95% confidence interval = 1.551-12.391.

** Odds ratio = 3.304, 95% confidence interval = 1.297-8.417.

Table 3.
Comparison of endoscopic findings and mesenteric vascular finding between two groups
Non-ILIC n = 46 ILIC n = 175 P-Value
Endoscopic findings 0.524
Severe 16 (34.8) 50 (28.6)
Moderate 24 (52.2) 91 (52.0)
Mild 6 (13.0) 34 (19.4)
Vascular findings†
SMA calcification, n (%) 23 (50.0) 86 (49.1) 0.918
SMA atherosclerosis, n (%) 6 (13.0) 4 (2.3) 0.006*
SMA stenosis, n (%) 6 (13.0) 2 (1.2) 0.001**
IMA atherosclerosis, n (%) 1 (2.1) 4 (2.3) 0.964
Mesenteric ischenmia, n (%) 10 (21.7) 4 (2.3) 0.497

ILIC, isolated left side ischemic colitis; Non-ILIC, non isolated left side ischemic colitis; SMA, superior mesenteric artery; IMA, inferior mesenteric artery.

† Vascular findings were accessed by dynamic computed tomography and angiography.

* Odds ratio = 6.412, 95% confidence interval = 1.728 to 23.793.

** Odds ratio = 12.975, 95% confidence interval = 2.525 to 66.677.

Table 4.
Clinical course between Non-ILIC and ILIC
Non-ILIC n = 46 ILIC n = 175 P-Value
Recovery period of ischemic colitis†, days, mean ± SD 9.5 ± 13.1 5.3 ± 8.5 0.039*
Hospitalization period, days, mean ± SD 24.8 ± 17.1 19.6 ± 16.6 0.061
Operation, n (%) 5 (10.8) 5 (2.9) 0.035**

ILIC, isolated left side ischemic colitis; Non-ILIC, non isolated left side ischemic colitis.

† Recovery period is the days between symptom onset and the resolution of ischemic colitis proved by colonoscopy.

* 95% confidence interval = 0.210-8.272.

** Odds ratio = 4.146, 95% confidence interval = 1.146-14.997.

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