TY - JOUR
T1 - Clinical patterns and outcomes of ischaemic colitis
T2 - Results of the Working Group for the Study of Ischaemic Colitis in Spain (CIE study)
AU - Montoro, Miguel A.
AU - Brandt, Lawrence J.
AU - Santolaria, Santos
AU - Gomollon, Fernando
AU - Puértolas, Belén Sánchez
AU - Vera, Jesús
AU - Bujanda, Luis
AU - Cosme, Angel
AU - Cabriada, José Luis
AU - Durán, Margarita
AU - Mata, Laura
AU - Santamaría, Ana
AU - Ceña, Gloria
AU - Blas, Jose Manuel
AU - Ponce, Julio
AU - Ponce, Marta
AU - Rodrigo, Luis
AU - Ortiz, Jacobo
AU - Muñoz, Carmen
AU - Arozena, Gloria
AU - Ginard, Daniel
AU - López-Serrano, Antonio
AU - Castro, Manuel
AU - Sans, Miquel
AU - Campo, Rafael
AU - Casalots, Alex
AU - Orive, Víctor
AU - Loizate, Alberto
AU - Titó, Lluçia
AU - Portabella, Eva
AU - Otazua, Pedro
AU - Calvo, M.
AU - Botella, Maria Teresa
AU - Thomson, Concepción
AU - Mundi, Jose Luis
AU - Quintero, Enrique
AU - Nicolás, David
AU - Borda, Fernando
AU - Martinez, Benito
AU - Gisbert, Javier P.
AU - Chaparro, María
AU - Bernadó, Alfredo Jimenez
AU - Gómez-Camacho, Federico
AU - Cerezo, Antonio
AU - Nuñez, Enrique Casal
N1 - Funding Information:
This study was supported by a grant from Novartis Pharmaceutical S.A. and from Aragonesse Society of Gastroenterology (www.aragonesadigestivo.org).
PY - 2011/2
Y1 - 2011/2
N2 - Background. There is a lack of prospective studies evaluating the natural history of colonic ischaemia (CI). We performed such a study to evaluate the clinical presentation, outcome, and mortality as well as clinical variables associated with poor prognosis. Methods. An open, prospective, and multicentre study was conducted in 24 Spanish hospitals serving a population of 3.5 million people. The study included only patients who met criteria for definitive or probable CI. A website (www.colitisisquemica.org) provided logistical support. Results. A total of 364 patients met criteria for inclusion. CI was suspected clinically in only 24.2% of cases. The distribution of clinical patterns was as follows: reversible colopathy (26.1%), transient colitis (43.7%), gangrenous colitis (9.9%), fulminant pancolitis (2.5%), and chronic segmental colitis (17.9%). A total of 47 patients (12.9%) had an unfavorable outcome as defined by mortality and/or the need for surgery. Multivariate analysis identified the following signs as independent risk factors for an unfavorable outcome: abdominal pain without rectal bleeding [odds ratio (OR) 3.9; 95% confidence interval (CI) = 1.6-9.3], non-bloody diarrhoea (OR 10; 95% CI = 3.7-27.4), and peritoneal signs (OR 7.3; 95% CI = 2.7-19.6). Unfavorable outcomes also were more frequent in isolated right colon ischaemia (IRCI) compared with non-IRCI (40.9 vs. 10.3%, respectively; p < 0.0001). The overall mortality rate was 7.7%. Conclusions. The clinical presentation of CI is very heterogeneous, perhaps explaining why clinical suspicion of this disease is so low. The presence of IRCI, and occurrence of peritoneal signs or onset of CI as severe abdominal pain without bleeding, should alert the physician to a potentially unfavorable course.
AB - Background. There is a lack of prospective studies evaluating the natural history of colonic ischaemia (CI). We performed such a study to evaluate the clinical presentation, outcome, and mortality as well as clinical variables associated with poor prognosis. Methods. An open, prospective, and multicentre study was conducted in 24 Spanish hospitals serving a population of 3.5 million people. The study included only patients who met criteria for definitive or probable CI. A website (www.colitisisquemica.org) provided logistical support. Results. A total of 364 patients met criteria for inclusion. CI was suspected clinically in only 24.2% of cases. The distribution of clinical patterns was as follows: reversible colopathy (26.1%), transient colitis (43.7%), gangrenous colitis (9.9%), fulminant pancolitis (2.5%), and chronic segmental colitis (17.9%). A total of 47 patients (12.9%) had an unfavorable outcome as defined by mortality and/or the need for surgery. Multivariate analysis identified the following signs as independent risk factors for an unfavorable outcome: abdominal pain without rectal bleeding [odds ratio (OR) 3.9; 95% confidence interval (CI) = 1.6-9.3], non-bloody diarrhoea (OR 10; 95% CI = 3.7-27.4), and peritoneal signs (OR 7.3; 95% CI = 2.7-19.6). Unfavorable outcomes also were more frequent in isolated right colon ischaemia (IRCI) compared with non-IRCI (40.9 vs. 10.3%, respectively; p < 0.0001). The overall mortality rate was 7.7%. Conclusions. The clinical presentation of CI is very heterogeneous, perhaps explaining why clinical suspicion of this disease is so low. The presence of IRCI, and occurrence of peritoneal signs or onset of CI as severe abdominal pain without bleeding, should alert the physician to a potentially unfavorable course.
KW - Abdominal pain
KW - bleeding
KW - colorectal disease
KW - diarrhoea
KW - ischaemia
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U2 - 10.3109/00365521.2010.525794
DO - 10.3109/00365521.2010.525794
M3 - Article
C2 - 20961178
AN - SCOPUS:79951750125
SN - 0036-5521
VL - 46
SP - 236
EP - 246
JO - Scandinavian Journal of Gastroenterology
JF - Scandinavian Journal of Gastroenterology
IS - 2
ER -