Ischemic colitis: Incidence, Risk Factors, Clinical Manifestation and Outcome
Introduction: Ischemic colitis (IC) is the most prevalent form of gastrointestinal ischemia and the second most common cause for lower gastrointestinal bleeding. The clinical course is diverse and the causes are many. Data on the incidence of IC in a population-based setting are largely lacking. The aims of this study were to determine the incidence, clinical manifestation and outcome of patients with IC, and to evaluate the prevalence of several risk factors for IC. Material and method: A retrospective study was conducted on all patients, 18 years and older, who were admitted to the National University Hospital of Iceland and the Akureyri District Hospital with IC during a 5-year period from 2009 through 2013. A histological confirmation of IC was required for the diagnosis. Patients were identified by search for ICD-10 codes in the diagnosis database, for the term “ischemic colitis” in the text of electronic medical records and by search in database of the pathological department. Data were collected on age, gender, comorbidities, smoking habit, clinical presentation, treatment and outcome. Results: A total of 89 patients fulfilled the predetermined criteria, 61 female (69%) and 28 males (31%). The overall mean age was 65 years (16.7), for females it was 68 years (14.1) but for males it was 59 years (20.1) (p=0.0170). The mean incidence rate was 7.3 cases per 100.000 inhabitants per year. A total of 62 (70%) of patients had cardiovascular disease and 55 (62%) had a history of smoking habit. A total of 57 (64%) patients presented with abdominal pain, hematochezia and diarrhea. IC was localized in the left colon in 78 (88%) patients. Ten (11%) patients required surgery and/or died during hospitalization. Isolated right-sided colitis and simultaneous involvement of the right and left colon were predictive of poor outcome (p=0.0009 and p=0002). The 5 year recurrence rate was 9%. Hypertension and absence of abdominal tenderness were predictive of recurrence (p=0.0472 and p=0008). At the end of follow-up, 13 (15%) patients had died, 5 (6%) died from IC but 8 (9%) had alternative causes of death. Mortality rate for those who underwent surgery, 5/8 (63%), was higher than for those who did not, 8/81 (10%) (p=0.0014). Conclusion: The mean incidence of IC was 7.3 cases per 100.000 inhabitants per year. Patients with ischemia confined to the right colon or located in both the left and right colon have worse prognosis. Patients diagnosed with hypertension and who present with no abdominal tenderness are more likely to experience recurrent IC. The high prevalence of smoking habit among patients with ischemic colitis warrants further research.
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