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RISK FACTORS AND SEQUELAE OF ISCHEMIC COLITIS
M Mosli, J Parfitt, J GregorDivision of Gastroenterology, Department of Medicine, The University of Western Ontario, London Health Sciences Centre, London, Ontario
AIMS: To identify the different risk factors, clinical presentations as well as the complications of ischemic colitis (IC) observed during the follow-up of patients with pathologically proven disease.
METHODS: We performed a retrospective analysis that studied patients (from 2006 to 2009) with pathology samples taken during colonoscopy that confirmed the diagnosis of IC. Patient's data was entered into a computerised database and subsequently analysed.
RESULTS: 73 patient's charts were examined; the mean age was 68.3 (17-92); 18/73 (25%) of patients were younger than the age of 65. 57/73 (78%) of patients were females. Risk factors for vascular disease included hypertension 55/73 (59%), elevated cholesterol 25/73 (34.7%), diabetes mellitus 14/73 (19.4%). Only 5/73 (6.9%) were current smokers. 24/73 (33%) patients had no identifiable risk factors although 8/24 (33.3%) met the criteria for irritable bowel syndrome. Concurrent anticoagulant therapy used included aspirin 24/73 (33.3%), clopidogrel 7/73 (9.72%) and coumadin 2/73 (2.8%). Presenting symptoms included abdominal pain 56/73 (77%), rectal bleeding 42/73 (58.3%) and diarrhea 39/73 (53.4%) of which 25/39 (64.1%) were bloody. The maximal area of endoscopic involvement was the splenic flexure 29/73 (40.3%) followed by diffuse involvement of the large bowel 17/73 (23.6%). The most common endoscopic finding was erythema 57/73 (79.2%) followed by ulceration 39/73 (54.2%). The mean haemoglobin level was 130 (41-174) and the mean serum creatinine was 123 (51-560). 70/73 (97.2%) patients were treated conservatively and 2/73 (2.7%) required surgical intervention. Over a mean length of follow-up of 7.2 months, only 2/73 (2.8%)
patients developed other vascular events (myocardial infarction or cerebrovascular attack) although there was recurrence of IC in 15/73 (20.8%) patients. 4/73 (5.6%) patients died during follow-up.
CONCLUSIONS: Most patients with IC do have identifiable risk factors for vascular disease. However, this condition still needs to be considered in younger patients with no identifiable risk factors. The recurrence rate is high but vascular incidents seem specific to the gastrointestinal tract. Further studies to elucidate the specific pathophysiology of IC may be of benefit to identify preventive measures.