Clinical patterns and outcomes of ischaemic colitis: results of the Working Group for the Study of Ischaemic Colitis in Spain (CIE study).
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.
Department of Gastroenterology, Hospital San Jorge, Huesca, Spain. montorohuguet@gmail.com
Miguel A
MA
Montoro
Lawrence J
LJ
Brandt
Santos
S
Santolaria
Fernando
F
Gomollon
Belén
B
Sánchez Puértolas
Jesús
J
Vera
Luis
L
Bujanda
Angel
A
Cosme
José Luis
JL
Cabriada
Margarita
M
Durán
Laura
L
Mata
Ana
A
Santamaría
Gloria
G
Ceña
Jose Manuel
JM
Blas
Julio
J
Ponce
Marta
M
Ponce
Luis
L
Rodrigo
Jacobo
J
Ortiz
Carmen
C
Muñoz
Gloria
G
Arozena
Daniel
D
Ginard
Antonio
A
López-Serrano
Manuel
M
Castro
Miquel
M
Sans
Rafael
R
Campo
Alex
A
Casalots
Víctor
V
Orive
Alberto
A
Loizate
Lluçia
L
Titó
Eva
E
Portabella
Pedro
P
Otazua
M
M
Calvo
Maria Teresa
MT
Botella
Concepción
C
Thomson
Jose Luis
JL
Mundi
Enrique
E
Quintero
David
D
Nicolás
Fernando
F
Borda
Benito
B
Martinez
Javier P
JP
Gisbert
María
M
Chaparro
Alfredo
A
Jimenez Bernadó
Federico
F
Gómez-Camacho
Antonio
A
Cerezo
Enrique
E
Casal Nuñez
D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D017091:Colitis, Ischemic / Q000401:mortality / Q000473:pathology* / Q000503:physiopathology*; D003113:Colonoscopy; D003672:Defecation; D003967:Diarrhea / Q000473:pathology*; D005260:Female; D005734:Gangrene; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010537:Peritoneum / Q000503:physiopathology*; D011379:Prognosis; D011446:Prospective Studies; D012007:Rectum / Q000473:pathology; D013030:Spain