Cocaine-induced ischemic colitis

Review article: the pharmacological causes of colon ischaemia

BACKGROUND

Colon ischaemia is the most common ischaemic disorder of the gastrointestinal system, can affect any segment of the colon, and may present with a range of symptoms. Diagnosis can be challenging due to symptom overlap with other conditions, varied aetiology, and often rapid and self-resolving course.

AIM

To review comprehensively the literature regarding the pharmacological aetiologies of colonic ischaemia to enhance the understanding of the various mechanisms of disease, presentations, distribution, and outcomes.

METHODS

A PubMed search for "colon ischaemia" and "ischaemic colitis" alone as well as in combination with various known pharmacologic causes was performed. Only the highest quality and relevant literature was included in this review. The quality of the literature for each association was rated by the authors and a consensus was made when discrepancies were encountered. Only associations that were deemed "moderate" or "strong" were included.

RESULTS

The literature considering pharmacologically associated colonic ischaemia is diverse, lacks codification and is characterised by numerous case reports and case series. Constipation-inducing drugs, digoxin, hormonal therapies, illicit drugs, immunomodulators, laxatives, and NSAIDs were strongly associated with colonic ischaemia. Antimicrobials, appetite suppressants, chemotherapies, decongestants, diuretics, ergot alkaloids, serotonin agents, statins, and vasopressor agents were moderately associated.

CONCLUSIONS

Patients presenting with abdominal pain, diarrhoea, or bloody stool need to be evaluated for the possibility of this condition and treated accordingly. Timely diagnosis is necessary to improve patient outcomes. This review aims to increase awareness among clinicians regarding the presentation of pharmacologically induced colonic ischaemia.

Retrospective analysis of disease association and outcome in histologically confirmed ischemic colitis

OBJECTIVE

To identify risk factors, clinical features and complications in patients with ischemic colitis (IC).

METHODS

All patients diagnosed with biopsy proven IC within a 2-year period were identified; clinical data were retrospectively collected and subsequently analyzed.

RESULTS

In total, 72 IC patients with a mean age of 68 years were included in this study. Among them, 18 (25.0%) were younger than 65 years with a female predominance. One-third of the patients was found to be without vascular risk factors, and 8 patients met the criteria for irritable bowel syndrome. No history of oral contraceptives or hormonal replacement therapy use could be found among the women diagnosed with IC. Over a mean duration of follow-up of 9.5 months (range 0-65 months), the rate of recurrent disease was 16.7%, while only 2 (2.8%) patients developed extra intestinal vascular sequelae. Statistical analysis identified a history of atrial fibrillation and the use of furosemide to be the only significant predictors of a poor outcome, while coronary artery disease and chronic renal failure predicted recurrence and low platelet count predicted stricture formation.

CONCLUSIONS

Although most patients with IC are elderly and have conventional vascular risk factors, it should also be considered in young patients without vascular risk factors, especially in women, who may have an atypical distribution of the disease. Severe complications and extraintestinal vascular sequelae are rare, however, residual gastrointestinal complaints and recurrent disease are relatively common and there are no reliable predictors of the outcome.