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

2010; Taylor & Francis; Volume: 46; Issue: 2 Linguagem: Inglês

10.3109/00365521.2010.525794

1502-7708

Miguel Montoro, Lawrence J. Brandt, Santos Santolaria, Fernando Gomollón, Belén Sánchez Puértolas, Jesus Diaz Vera, Luís Bujanda, Ángel Cosme, José Luis Cabriada, Margarita Durán, Laura Mata, Ana Raquel Santa-Maria, Gloria Ceña, José Manuel Blas, Julio Ponce, Marta Ponce, Luı́s Rodrigo, Jacobo Ortiz, Carmen Muñoz, Gloria Arozena, Daniel Ginard, Antonio López‐Serrano, Manuel Castro de Moura, Miquel Sans, Rafael Campo, Àlex Casalots, Víctor Orive Serrano, Alberto Loizate, Lluçia Titó, E. Cantal Portabella, Pedro Otazua, Mariano Calvo, Maria Teresa Botella, Concepción Thomson, José Luis Mundi, Enrique Quintero, David Nicolás, Fernando Borda, B. Martínez, Javier P. Gisbert, María Chaparro, Alfredo Jiménez Bernadó, Federico Gómez-Camacho, Antonio Martínez Cerezo, Enrique Núñez,

Esophageal and GI Pathology

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.