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.
Montoro
Miguel A
MA
Department of Gastroenterology, Hospital San Jorge, Huesca, Spain. montorohuguet@gmail.com
Brandt
Lawrence J
LJ
Santolaria
Santos
S
Gomollon
Fernando
F
Sánchez Puértolas
Belén
B
Vera
Jesús
J
Bujanda
Luis
L
Cosme
Angel
A
Cabriada
José Luis
JL
Durán
Margarita
M
Mata
Laura
L
Santamaría
Ana
A
Ceña
Gloria
G
Blas
Jose Manuel
JM
Ponce
Julio
J
Ponce
Marta
M
Rodrigo
Luis
L
Ortiz
Jacobo
J
Muñoz
Carmen
C
Arozena
Gloria
G
Ginard
Daniel
D
López-Serrano
Antonio
A
Castro
Manuel
M
Sans
Miquel
M
Campo
Rafael
R
Casalots
Alex
A
Orive
Víctor
V
Loizate
Alberto
A
Titó
Lluçia
L
Portabella
Eva
E
Otazua
Pedro
P
Calvo
M
M
Botella
Maria Teresa
MT
Thomson
Concepción
C
Mundi
Jose Luis
JL
Quintero
Enrique
E
Nicolás
David
D
Borda
Fernando
F
Martinez
Benito
B
Gisbert
Javier P
JP
Chaparro
María
M
Jimenez Bernadó
Alfredo
A
Gómez-Camacho
Federico
F
Cerezo
Antonio
A
Casal Nuñez
Enrique
E
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