Clinical patterns and outcomes of ischaemic colitis: Results of the Working Group for the Study of Ischaemic Colitis in Spain (CIE study)

Miguel A. Montoro, Lawrence J. Brandt, Santos Santolaria, Fernando Gomollon, Belén Sánchez Puértolas, Jesús Vera, Luis Bujanda, Angel Cosme, José Luis Cabriada, Margarita Durán, Laura Mata, Ana Santamaría, Gloria Ceña, Jose Manuel Blas, Julio Ponce, Marta Ponce, Luis Rodrigo, Jacobo Ortiz, Carmen Muñoz, Gloria ArozenaDaniel Ginard, Antonio López-Serrano, Manuel Castro, Miquel Sans, Rafael Campo, Alex Casalots, Víctor Orive, Alberto Loizate, Lluçia Titó, Eva Portabella, Pedro Otazua, M. Calvo, Maria Teresa Botella, Concepción Thomson, Jose Luis Mundi, Enrique Quintero, David Nicolás, Fernando Borda, Benito Martinez, Javier P. Gisbert, María Chaparro, Alfredo Jimenez Bernadó, Federico Gómez-Camacho, Antonio Cerezo, Enrique Casal Nuñez

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)236-246
Number of pages11
JournalScandinavian Journal of Gastroenterology
Volume46
Issue number2
DOIs
StatePublished - Feb 2011

Fingerprint

Ischemic Colitis
Spain
Ischemia
Colitis
Colon
Odds Ratio
Abdominal Pain
Mortality
Prospective Studies
Hospital Distribution Systems
Hemorrhage
Multicenter Studies
Diarrhea
Multivariate Analysis
Confidence Intervals

Keywords

  • Abdominal pain
  • bleeding
  • colorectal disease
  • diarrhoea
  • ischaemia

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Clinical patterns and outcomes of ischaemic colitis : Results of the Working Group for the Study of Ischaemic Colitis in Spain (CIE study). / Montoro, Miguel A.; Brandt, Lawrence J.; Santolaria, Santos; Gomollon, Fernando; Puértolas, Belén Sánchez; Vera, Jesús; Bujanda, Luis; Cosme, Angel; Cabriada, José Luis; Durán, Margarita; Mata, Laura; Santamaría, Ana; Ceña, Gloria; Blas, Jose Manuel; Ponce, Julio; Ponce, Marta; Rodrigo, Luis; Ortiz, Jacobo; Muñoz, Carmen; Arozena, Gloria; Ginard, Daniel; López-Serrano, Antonio; Castro, Manuel; Sans, Miquel; Campo, Rafael; Casalots, Alex; Orive, Víctor; Loizate, Alberto; Titó, Lluçia; Portabella, Eva; Otazua, Pedro; Calvo, M.; Botella, Maria Teresa; Thomson, Concepción; Mundi, Jose Luis; Quintero, Enrique; Nicolás, David; Borda, Fernando; Martinez, Benito; Gisbert, Javier P.; Chaparro, María; Bernadó, Alfredo Jimenez; Gómez-Camacho, Federico; Cerezo, Antonio; Nuñez, Enrique Casal.

In: Scandinavian Journal of Gastroenterology, Vol. 46, No. 2, 02.2011, p. 236-246.

Research output: Contribution to journalArticle

Montoro, MA, Brandt, LJ, Santolaria, S, Gomollon, F, Puértolas, BS, Vera, J, Bujanda, L, Cosme, A, Cabriada, JL, Durán, M, Mata, L, Santamaría, A, Ceña, G, Blas, JM, Ponce, J, Ponce, M, Rodrigo, L, Ortiz, J, Muñoz, C, Arozena, G, Ginard, D, López-Serrano, A, Castro, M, Sans, M, Campo, R, Casalots, A, Orive, V, Loizate, A, Titó, L, Portabella, E, Otazua, P, Calvo, M, Botella, MT, Thomson, C, Mundi, JL, Quintero, E, Nicolás, D, Borda, F, Martinez, B, Gisbert, JP, Chaparro, M, Bernadó, AJ, Gómez-Camacho, F, Cerezo, A & Nuñez, EC 2011, 'Clinical patterns and outcomes of ischaemic colitis: Results of the Working Group for the Study of Ischaemic Colitis in Spain (CIE study)', Scandinavian Journal of Gastroenterology, vol. 46, no. 2, pp. 236-246. https://doi.org/10.3109/00365521.2010.525794
Montoro, Miguel A. ; Brandt, Lawrence J. ; Santolaria, Santos ; Gomollon, Fernando ; Puértolas, Belén Sánchez ; Vera, Jesús ; Bujanda, Luis ; Cosme, Angel ; Cabriada, José Luis ; Durán, Margarita ; Mata, Laura ; Santamaría, Ana ; Ceña, Gloria ; Blas, Jose Manuel ; Ponce, Julio ; Ponce, Marta ; Rodrigo, Luis ; Ortiz, Jacobo ; Muñoz, Carmen ; Arozena, Gloria ; Ginard, Daniel ; López-Serrano, Antonio ; Castro, Manuel ; Sans, Miquel ; Campo, Rafael ; Casalots, Alex ; Orive, Víctor ; Loizate, Alberto ; Titó, Lluçia ; Portabella, Eva ; Otazua, Pedro ; Calvo, M. ; Botella, Maria Teresa ; Thomson, Concepción ; Mundi, Jose Luis ; Quintero, Enrique ; Nicolás, David ; Borda, Fernando ; Martinez, Benito ; Gisbert, Javier P. ; Chaparro, María ; Bernadó, Alfredo Jimenez ; Gómez-Camacho, Federico ; Cerezo, Antonio ; Nuñez, Enrique Casal. / Clinical patterns and outcomes of ischaemic colitis : Results of the Working Group for the Study of Ischaemic Colitis in Spain (CIE study). In: Scandinavian Journal of Gastroenterology. 2011 ; Vol. 46, No. 2. pp. 236-246.
@article{a0f6503604bd4c1a82a64b8624b17bc9,
title = "Clinical patterns and outcomes of ischaemic colitis: Results of the Working Group for the Study of Ischaemic Colitis in Spain (CIE study)",
abstract = "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.",
keywords = "Abdominal pain, bleeding, colorectal disease, diarrhoea, ischaemia",
author = "Montoro, {Miguel A.} and Brandt, {Lawrence J.} and Santos Santolaria and Fernando Gomollon and Pu{\'e}rtolas, {Bel{\'e}n S{\'a}nchez} and Jes{\'u}s Vera and Luis Bujanda and Angel Cosme and Cabriada, {Jos{\'e} Luis} and Margarita Dur{\'a}n and Laura Mata and Ana Santamar{\'i}a and Gloria Ce{\~n}a and Blas, {Jose Manuel} and Julio Ponce and Marta Ponce and Luis Rodrigo and Jacobo Ortiz and Carmen Mu{\~n}oz and Gloria Arozena and Daniel Ginard and Antonio L{\'o}pez-Serrano and Manuel Castro and Miquel Sans and Rafael Campo and Alex Casalots and V{\'i}ctor Orive and Alberto Loizate and Llu{\cc}ia Tit{\'o} and Eva Portabella and Pedro Otazua and M. Calvo and Botella, {Maria Teresa} and Concepci{\'o}n Thomson and Mundi, {Jose Luis} and Enrique Quintero and David Nicol{\'a}s and Fernando Borda and Benito Martinez and Gisbert, {Javier P.} and Mar{\'i}a Chaparro and Bernad{\'o}, {Alfredo Jimenez} and Federico G{\'o}mez-Camacho and Antonio Cerezo and Nu{\~n}ez, {Enrique Casal}",
year = "2011",
month = "2",
doi = "10.3109/00365521.2010.525794",
language = "English (US)",
volume = "46",
pages = "236--246",
journal = "Scandinavian Journal of Gastroenterology",
issn = "0036-5521",
publisher = "Informa Healthcare",
number = "2",

}

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

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

UR - http://www.scopus.com/inward/record.url?scp=79951750125&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79951750125&partnerID=8YFLogxK

U2 - 10.3109/00365521.2010.525794

DO - 10.3109/00365521.2010.525794

M3 - Article

C2 - 20961178

AN - SCOPUS:79951750125

VL - 46

SP - 236

EP - 246

JO - Scandinavian Journal of Gastroenterology

JF - Scandinavian Journal of Gastroenterology

SN - 0036-5521

IS - 2

ER -