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 journalArticlepeer-review

79 Scopus citations

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

Keywords

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

ASJC Scopus subject areas

  • Gastroenterology

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