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Masterman BJ, Ambulkar T, Hartrick O. Exercise-Induced Ischemic Colitis From Home-Based High-Intensity Interval Training (HIIT). Cureus 2024; 16:e55791. [PMID: 38586719 PMCID: PMC10999238 DOI: 10.7759/cureus.55791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/04/2024] [Indexed: 04/09/2024] Open
Abstract
The current case presents a male in his 40s without significant past medical, surgical, or family history. Hematochezia started immediately after one hour of high-intensity interval training (HIIT), which included free-weight exercises and a circuit training instructional video. Relevant investigations included negative stool cultures and flexible sigmoidoscopy showing ischemic colitis in the mid-sigmoid. Histology also supported ischemic etiology, leading to the diagnosis of exercise-induced ischemic colitis (EIIC). The patient made a full recovery following supportive treatment, including intravenous fluid. To our knowledge, this is the first reported case of ischemic colitis secondary to HIIT performed at home. The case reviews risk factors for EIIC and highlights the diagnosis as being possible outside the context of long-distance and endurance exercise.
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Affiliation(s)
| | - Tanvi Ambulkar
- General Internal Medicine, Great Western Hospitals NHS Foundation Trust, Swindon, GBR
| | - Olivia Hartrick
- General Internal Medicine, Great Western Hospitals NHS Foundation Trust, Swindon, GBR
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2
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Parfenov AI, Kagramanova AV, Khomeriki SG, Kulakov DS. [Modern concept of differential diagnosis of colitis: from G.F. Lang to the present day. A review]. TERAPEVT ARKH 2023; 95:1022-1030. [PMID: 38158934 DOI: 10.26442/00403660.2023.12.202496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
The aim of the article is to improve the differential diagnosis of specific and nonspecific inflammatory bowel diseases. In Russia, this scientific direction is associated with the name of G.F. Lang, who performed in 1901-1902 the study "On ulcerative inflammation of the large intestine caused by balantidiasis". The etiology of specific colitis is associated with infection with parasites, bacteria and viruses that cause inflammation of the intestinal wall, diarrhea, often with an admixture of mucus, pus and blood. Specific colitis (SC) may be accompanied by fever, abdominal pain, and tenesmus. Bacterial colitis is commonly caused by Salmonella, Shigella, Escherichia coli, Clostridium difficile, Campylobacter jejuni, Yersinia enterocolitica, and Mycobacterium tuberculosis. Viral colitis is caused by rotavirus, adenovirus, cytomegalovirus, and norovirus. Parasitic colitis can be caused by Entamoeba histolytica and balantidia. In gay people, SC can cause sexually transmitted infections: Neisseria gonorrhoeae, Chlamydia trachomatis, and treponema pallidum, affecting the rectum. Stool microscopy, culture, and endoscopy are used to establish the diagnosis. Stool culture helps in the diagnosis of bacterial colitis in 50% of patients, and endoscopic studies reveal only nonspecific pathological changes. Differential diagnosis of SC should be carried out with immune-inflammatory bowel diseases (ulcerative colitis, Crohn's disease, undifferentiated colitis), radiation colitis and other iatrogenic bowel lesions. The principles of diagnosis and therapy of inflammatory bowel diseases associated with various etiological.
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Affiliation(s)
| | - A V Kagramanova
- Loginov Moscow Clinical Scientific Center
- Research Institute of Healthcare Organization and Medical Management
| | | | - D S Kulakov
- Loginov Moscow Clinical Scientific Center
- Research Institute of Healthcare Organization and Medical Management
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3
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Chong Tai LI, Ahmed S, Chokshi RR. Ischemic Colitis in a Young Female Following Herbal Supplement Ingestion. Cureus 2023; 15:e45315. [PMID: 37846238 PMCID: PMC10577007 DOI: 10.7759/cureus.45315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/18/2023] Open
Abstract
Ischemic colitis is typically considered a disease of the elderly, given their atherosclerotic risk factors and other comorbidities. Ischemic colitis in the younger population is considered very uncommon. We present an interesting case of a young female presenting with abdominal pain and hematochezia found to have ischemic colitis on pathological biopsy results after a colonoscopy. She was an otherwise healthy female with no medical problems prior to her hospitalization but endorsed recent use of a bitter herbal tea to relieve her symptoms. Here, we review potential causes of ischemic colitis, including herbal remedies, which have been linked to causing hypercoagulable and hypotensive states.
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Affiliation(s)
| | - Syed Ahmed
- Internal Medicine, Broward Health Medical Center, Fort Lauderdale, USA
| | - Rajiv R Chokshi
- Internal Medicine, Broward General Medical Center, Fort Lauderdale, USA
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4
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Takatsu T, Misawa N, Yoshihara T, Ashikari K, Kessoku T, Ohkubo H, Hosono K, Yoneda M, Saito S, Nakajima A, Higurashi T. Prior appendectomy and cerebral infarction as potential risk factors for recurrent ischemic colitis: A retrospective observational study. JGH Open 2023; 7:559-566. [PMID: 37649858 PMCID: PMC10463018 DOI: 10.1002/jgh3.12948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 07/01/2023] [Accepted: 07/05/2023] [Indexed: 09/01/2023]
Abstract
Background and Aim Ischemic colitis (IC) is a benign disease associated with acute lower gastrointestinal bleeding and frequent recurrence. While several studies have investigated risk factors for IC onset, few have assessed the risk factors for recurrent IC. This study aimed to identify risk factors for recurrent IC. Methods Potential risk factors for recurrence were assessed by examining medical records and laboratory findings in this single-center retrospective study. We extracted the following data from the patients' medical records: patient characteristics, clinical signs and symptoms, laboratory findings, method of treatment, length of hospital stay, disease course, and the frequency of IC morbidities. Patients with IC were selected from a total of 439 312 patients over an 11-year period. Patients were divided into recurrent and nonrecurrent IC groups. Results In total, 225 patients met the diagnostic criteria for IC during the specified study period; of these, 204 patients (90.7%) and 21 patients (9.3%) were included in the nonrecurrent and recurrent IC groups, respectively. Univariate and multivariate analyses showed a significant association between IC recurrence and both cerebral infarction (P = 0.008, odds ratio [OR] = 6.3) and history of appendectomy (P = 0.0005, OR = 6.2). The median (interquartile range [IQR]) follow-up time for all patients was 1556 (353-2768) days; this was much longer than the median (IQR) time to recurrence of 291 (64-907) days in the recurrent IC group. Conclusion The results of this study suggest that prior cerebral infarction and appendicectomy may be risk factors for IC recurrence.
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Affiliation(s)
- Tomohiro Takatsu
- Department of Gastroenterology and HepatologyYokohama City University School of Medicine Graduate School of MedicineYokohamaJapan
- Department of GastroenterologySanno HospitalTokyoJapan
| | - Noboru Misawa
- Department of Gastroenterology and HepatologyYokohama City University School of Medicine Graduate School of MedicineYokohamaJapan
| | - Tsutomu Yoshihara
- Department of Gastroenterology and HepatologyYokohama City University School of Medicine Graduate School of MedicineYokohamaJapan
| | - Keiichi Ashikari
- Department of Gastroenterology and HepatologyYokohama City University School of Medicine Graduate School of MedicineYokohamaJapan
| | - Takaomi Kessoku
- Department of Gastroenterology and HepatologyYokohama City University School of Medicine Graduate School of MedicineYokohamaJapan
| | - Hidenori Ohkubo
- Department of Gastroenterology and HepatologyYokohama City University School of Medicine Graduate School of MedicineYokohamaJapan
| | - Kunihiro Hosono
- Department of Gastroenterology and HepatologyYokohama City University School of Medicine Graduate School of MedicineYokohamaJapan
| | - Masato Yoneda
- Department of Gastroenterology and HepatologyYokohama City University School of Medicine Graduate School of MedicineYokohamaJapan
| | - Satoru Saito
- Department of Gastroenterology and HepatologyYokohama City University School of Medicine Graduate School of MedicineYokohamaJapan
| | - Atsushi Nakajima
- Department of Gastroenterology and HepatologyYokohama City University School of Medicine Graduate School of MedicineYokohamaJapan
| | - Takuma Higurashi
- Department of Gastroenterology and HepatologyYokohama City University School of Medicine Graduate School of MedicineYokohamaJapan
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5
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Inban P, Carredo CKC, Arslan F, Odoma VA, Okobia I, Adegbite A, Sharma S, Kc S, Zahdeh T, Rentiya ZS. Small Bowel Lymphoma Complicated With Ischemic Colitis: A Case Report. Cureus 2023; 15:e41792. [PMID: 37575763 PMCID: PMC10421726 DOI: 10.7759/cureus.41792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Ischemic colitis is thought to be an injury to the colon as a result of reduced blood flow. Certain infectious diseases such as the Epstein-Barr virus can aid in the reduction of blood flow. The insult can range from inflammation and superficial injury to full-thickness necrosis. The typical regions affected are the "watershed" areas of the colon: the splenic flexure, the rectosigmoid junction, and the right colon. Because patients can present with a wide spectrum of symptoms from vague abdominal discomfort to complete abdominal catastrophe, the diagnosis of ischemic colitis is sometimes challenging to make. Patients typically present with the acute onset of crampy abdominal pain and usually pass blood mixed with stool within 24 hours. Endoscopically, ischemia is suspected in the presence of bluish hemorrhagic nodules from submucosal bleeding, cyanotic or necrotic mucosa with bleeding ulcerations, or a segmental distribution with an abrupt transition point between injured and normal mucosa. We present a case of an 80-year-old male with a history of hypertension, hyperlipidemia, and basal cell carcinoma of the scalp diagnosed with ischemic colitis associated with positive Epstein-Barr virus B cell lymphoma.
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Affiliation(s)
- Pugazhendi Inban
- Department of General Medicine, Government Medical College, Omandurar, Chennai, IND
| | | | - Faiza Arslan
- Department of Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | - Victor A Odoma
- Department of Cardiology/Oncology, Indiana Iniversity (IU) Health, Bloomington, USA
| | - Isioma Okobia
- Department of Surgery, University of Benin Medical School, Benin City, NGA
| | | | - Shristi Sharma
- Department of Internal Medicine, University of Dhaka, Dhaka, BGD
| | - Sandip Kc
- Department of Internal Medicine, University of Dhaka, Dhaka, BGD
| | - Tamer Zahdeh
- Department of Internal Medicine, Hadassah Medical Center, Jerusalem, ISR
| | - Zubir S Rentiya
- Department of Surgery, MedStar Georgetown University Hospital, Washington, USA
- Department of Radiation Oncology & Radiology, University of Virginia School of Medicine, Charlottesville, USA
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6
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Cirocchi R, Randolph J, Cheruiyot I, Davies RJ, Gioia S, Henry BM, Anania G, Donini A, Mingoli A, Sapienza P, Avenia S. Discontinuity of marginal artery at splenic flexure and rectosigmoid junction: A systematic review and meta-analysis. Colorectal Dis 2023. [PMID: 37317032 DOI: 10.1111/codi.16624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 02/08/2023] [Accepted: 04/02/2023] [Indexed: 06/16/2023]
Abstract
AIM The aim of this study was to provide comprehensive evidence-based assessment of the discontinuity of the marginal artery at the splenic flexure (SF) and the rectosigmoid junction (RSJ). METHOD A systematic review was conducted of literature published to 26 December 2022 in the electronic databases PubMed, SCOPUS and Web of Science to identify studies eligible for inclusion. Data were extracted and pooled into a meta-analysis using the Metafor package in R. The primary outcomes were the pooled PPEs of the marginal artery at the SF and the RSJ. The secondary outcome was the size of vascular anastomoses. RESULTS A total of 21 studies (n = 2,864 patients) were included. The marginal artery was present at the splenic flexure in 82% (95% CI: 62-95) of patients. Approximately 81% (95% CI: 63-94%) of patients had a large macroscopic anastomosis, while the remainder (19%) had small bridging ramifications forming the vessel. The marginal artery was present at the RSJ in 82% (95% CI: 70-91%) of patients. CONCLUSION The marginal artery may be absent at the SF and the RSJ in up to 18% of individuals, which may confer a higher risk of ischaemic colitis. As a result of high interstudy heterogeneity noted in our analysis, further well-powered studies to clarify the prevalence of the marginal artery at the SF and the RSJ, as well as its relationship with other complementary colonic collaterals (intermediate and central mesenteric), are warranted.
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Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, Piazza dell' Universitá, Perugia, Italy
| | - Justus Randolph
- Georgia Baptist College of Nursing, Mercer University, Atlanta, USA
| | - Isaac Cheruiyot
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
- International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - R Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- University of Cambridge, Cambridge, UK
| | - Sara Gioia
- Section of Legal Medicine, Hospital of Terni, Terni, Italy
| | | | - Gabriele Anania
- Department of Medical Science, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Annibale Donini
- Department of Medicine and Surgery, University of Perugia, Piazza dell' Universitá, Perugia, Italy
| | - Andrea Mingoli
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Paolo Sapienza
- Department of Surgery "Pietro Valdoni", "Sapienza" University of Rome, Rome, Italy
| | - Stefano Avenia
- Department of Medicine and Surgery, University of Perugia, Piazza dell' Universitá, Perugia, Italy
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Wongtrakul W, Charoenngam N, Ungprasert P. The association between irritable bowel syndrome and ischemic colitis: a systematic review and meta-analysis. Minerva Gastroenterol (Torino) 2022; 68:470-474. [PMID: 34547858 DOI: 10.23736/s2724-5985.21.02957-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Studies have suggested an association between ischemic colitis and irritable bowel syndrome (IBS) although the results were inconsistent. This systematic review and meta-analysis were performed to comprehensively examine the association between IBS and ischemic colitis by identifying all available cohort and case-control studies and combining their effect estimates together. EVIDENCE ACQUISITION EMBASE, MEDLINE and Google Scholar databases were systematically reviewed up to June 2020. Eligible study had to be either cohort or case-control studies that evaluated whether patients with IBS have a higher risk of ischemic colitis than individuals without IBS. Point estimates and standard errors from each eligible study were combined together using the generic inverse variance method of DerSimonian and Laird. EVIDENCE SYNTHESIS The systematic review identified three cohort and eight case-control studies. The pooled analysis found a significantly higher risk of ischemic colitis among patient with IBS with the pooled odds ratio of 2.50 (95% CI, 2.00-3.14; I2 57%). Funnel plot was relatively symmetric and was not suggestive of presence of publication bias. CONCLUSIONS A significantly increased risk of ischemic colitis among patients with IBS was observed in this systematic review and meta-analysis.
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Affiliation(s)
- Wasit Wongtrakul
- Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand -
| | - Nipith Charoenngam
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Patompong Ungprasert
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA
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8
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Chen YC, Tsai YY, Chang SC, Chen HC, Ke TW, Fingerhut A, Chen WTL. Laparoscopic versus open emergent colectomy for ischemic colitis: a propensity score-matched comparison. World J Emerg Surg 2022; 17:53. [PMID: 36229844 PMCID: PMC9563494 DOI: 10.1186/s13017-022-00458-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/06/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Laparoscopic colectomy is rarely performed for ischemic colitis. The aim of this propensity score-matched study was to compare preoperative characteristics, intraoperative details and short-term outcomes for emergent laparoscopic colectomy versus the traditional open approach for patients with ischemic colitis.
Methods Retrospective review of 96 patients who underwent emergent colectomy for ischemic colitis between January 2011 and December 2020 (39 via laparoscopy, 57 via laparotomy) was performed. We compared short-term outcomes after using a one-to-one ratio and nearest-neighbor propensity score matching to obtain similar preoperative and intraoperative parameters in each group. Results Patients in the open group experienced more surgical site complications (52.6% vs. 23.0%, p = 0.004), more intra-abdominal abscesses (47.3% vs. 17.9%, p = 0.003), longer need for ventilator support (20 days vs. 0 days, p < 0.001), more major complications (77.2% vs. 43.5%, p = 0.001), higher mortality (49.1% vs. 20.5%, p = 0.004), and longer hospital stay (32 days vs. 19 days, p = 0.001). After propensity score matching (31 patients in each group), patients undergoing open (vs. laparoscopy) had more surgical site complications (45.1% vs. 19.4%, p = 0.030) and required longer ventilator support (14 vs. 3 days, p = 0.039). After multivariate analysis, Charlson Comorbidity Index (p = 0.024), APACHE II score (p = 0.001), and Favier’s classification (p = 0.023) were independent predictors of mortality. Conclusions Laparoscopic emergent colectomy for ischemic colitis is feasible and is associated with fewer surgical site complications and better respiratory function, compared to the open approach.
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Affiliation(s)
- Yi-Chang Chen
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC.,Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Yuan-Yao Tsai
- Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Sheng-Chi Chang
- Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Hung-Chang Chen
- Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Tao-Wei Ke
- Department of Colorectal Surgery, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Abe Fingerhut
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria
| | - William Tzu-Liang Chen
- Department of Colorectal Surgery, China Medical University Hsinchu Hospital, No. 199, Sec.1, Xinglong RD, Zhubei City, 30272, Hsinchu County, Taiwan, ROC.
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9
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Feakins R, Torres J, Borralho-Nunes P, Burisch J, Cúrdia Gonçalves T, De Ridder L, Driessen A, Lobatón T, Menchén L, Mookhoek A, Noor N, Svrcek M, Villanacci V, Zidar N, Tripathi M. ECCO Topical Review on Clinicopathological Spectrum and Differential Diagnosis of Inflammatory Bowel Disease. J Crohns Colitis 2022; 16:343-368. [PMID: 34346490 DOI: 10.1093/ecco-jcc/jjab141] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Many diseases can imitate inflammatory bowel disease [IBD] clinically and pathologically. This review outlines the differential diagnosis of IBD and discusses morphological pointers and ancillary techniques that assist with the distinction between IBD and its mimics. METHODS European Crohn's and Colitis Organisation [ECCO] Topical Reviews are the result of an expert consensus. For this review, ECCO announced an open call to its members and formed three working groups [WGs] to study clinical aspects, pathological considerations, and the value of ancillary techniques. All WGs performed a systematic literature search. RESULTS Each WG produced a draft text and drew up provisional Current Practice Position [CPP] statements that highlighted the most important conclusions. Discussions and a preliminary voting round took place, with subsequent revision of CPP statements and text and a further meeting to agree on final statements. CONCLUSIONS Clinicians and pathologists encounter a wide variety of mimics of IBD, including infection, drug-induced disease, vascular disorders, diverticular disease, diversion proctocolitis, radiation damage, and immune disorders. Reliable distinction requires a multidisciplinary approach.
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Affiliation(s)
- Roger Feakins
- Department of Cellular Pathology, Royal Free Hospital, London, and University College London, UK
| | - Joana Torres
- Department of Gastroenterology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Paula Borralho-Nunes
- Department of Pathology, Hospital Cuf Descobertas, Lisboa and Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Johan Burisch
- Gastrounit, Medical Division, Hvidovre Hospital, University of Copenhagen, Denmark
| | - Tiago Cúrdia Gonçalves
- Department of Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal.,School of Medicine, University of Minho, Braga/Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Lissy De Ridder
- Department of Paediatric Gastroenterology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, The Netherlands
| | - Ann Driessen
- Department of Pathology, University Hospital Antwerp, University Antwerp, Edegem, Belgium
| | - Triana Lobatón
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Luis Menchén
- Department of Digestive System Medicine, Hospital General Universitario-Insitituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Department of Medicine, Universidad Complutense, Madrid, Spain.,Centro de Investigación Biomédica En Red de Enfermedades Hepáticas y Digestivas [CIBEREHD], Madrid, Spain
| | - Aart Mookhoek
- Department of Pathology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Nurulamin Noor
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Magali Svrcek
- Department of Pathology, Sorbonne Université, AP-HP, Saint-Antoine Hospital, Paris, France
| | - Vincenzo Villanacci
- Department of Histopathology, Spedali Civili and University of Brescia, Brescia, Italy
| | - Nina Zidar
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Monika Tripathi
- Department of Histopathology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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10
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Outcomes of patients with ischemic colitis causing severe hematochezia managed medically or surgically. Langenbecks Arch Surg 2022; 407:1625-1636. [DOI: 10.1007/s00423-022-02441-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
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11
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Ai X, Chen Y, Qian J, Zhou B, Wang Z, Zhang Y, Li A, Gong F, Pan W, Shen B, Liu S. Prediction of severity and outcomes of colon ischaemia using a novel prognostic model: a clinical multicenter study. Ann Med 2021; 53:1914-1923. [PMID: 34726101 PMCID: PMC8567865 DOI: 10.1080/07853890.2021.1990391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 09/30/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To identify risk factors of disease severity and between mild and severe colon ischaemia (CI) patients and to improve clinical outcomes, this study aimed to explore a novel scoring model. METHODS Retrospective analyses of hospital records between January 2009 and December 2019 were included. Clinical manifestations, mortality, Oakland score, laboratory tests, colonoscopy, and histopathology were collected. Risk factors of severe CI were determined by univariate and multivariate logistic regression and used for the predicting model. RESULTS A total of 203 patients with CI were included. Serum C-reactive protein (CRP) and albumin ratio (CAR) were much higher in the severe CI group compared with that of the mild CI group (3.33 ± 1.78 versus 0.68 ± 0.97, p < .001). The Oakland score was much higher in the severe CI group (12.00 ± 3.02 versus 8.77 ± 1.63, p < .001). The histopathological finding of fibrin thrombi was an independent risk factor that predicted poor outcomes (20.00% versus. 1.09%, p < .001). Patients present with CAR ≥3.33, Oakland score ≥12, and histopathological fibrin thrombi were independent risk factors. In addition, the final scoring model was 0.042 × Oakland score + 1.040 × CAR + 3.412 × fibrin thrombi, the area under the curve (AUC) was 0.960 (95% confidence interval:0.930-0.990), and the sensitivity and specificity of the novel scoring model were 95% and 92%, respectively. CONCLUSIONS The novel prognostic model was established to predict CI severity and clinical outcomes efficiently.Key messagesIn this article, we discuss the scoring model for clinical outcomes of colon ischaemia patients.In our study, the sensitivity and specificity of a novel scoring model are very high.Thus, laboratory tests (CRP albumin ratio), Oakland score, and histopathological findings (fibrin thrombi) can be assessed efficiently for colon ischaemia outcomes.
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Affiliation(s)
- Xinbo Ai
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of Gastroenterology, Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, China
| | - Yuping Chen
- Department of Gastroenterology, Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, China
| | - Jiajian Qian
- Department of Pharmacy, Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, China
| | - Bin Zhou
- Department of Pathology, Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, China
| | - Zhenjiang Wang
- Department of Gastroenterology, Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, China
| | - Yanjun Zhang
- Department of Intensive Care Unit, Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, China
| | - Aimin Li
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Feiyue Gong
- Department of Gastroenterology, Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, China
| | - Wensheng Pan
- Department of Gastroenterology, Zhejiang Provincial Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, China
| | - Bo Shen
- The Inflammatory Bowel Disease Center at Columbia, Columbia University Irving Medical Center, New York, NY, USA
| | - Side Liu
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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12
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Lorenzo D, Barthet M, Serrero M, Beyer L, Berdah S, Birnbaum D, Vitton V, Gonzalez JM. Severe acute ischemic colitis: What is the place of endoscopy in the management strategy? Endosc Int Open 2021; 9:E1770-E1777. [PMID: 34790544 PMCID: PMC8589548 DOI: 10.1055/a-1561-2259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background and study aims Ischemic colitis (IC) is potentially lethal. Clinical and biology information and results of computed tomography (CT) scan and/or colonoscopy are used to assess its severity. However, decision-making about therapy remains a challenge. Patients and methods This was a retrospective, single-center study between 2006 and 2015. Patients with severe IC who underwent endoscopic evaluation were included. The aims were to determine outcomes depending on endoscopic findings and assess the role of endoscopy in the management. Results A total of 71 patients were included (men = 48 (68%), mean age = 71 ± 13 years). There was hemodynamic instability in 29 patients (41 %) and severity signs on CT scan in 18 (38 %). Twenty-nine patients (41 %) underwent surgery and 24 (34 %) died. The endoscopic grades were: 15 grade 1 (21 %), 32 grade 2 (45 %), and 24 grade 3 (34%). Regarding patients with grade 3 IC, 55 % had hemodynamic instability, 58 % had severity signs on CT scan, 68 % underwent surgery, and 55 % died. The decision to perform surgery was based on hemodynamic status in 62 % of cases, CT scan data in 14 %, endoscopic findings in 10 %, and other in 14 %. Colectomy was more frequent in patients with grade 3 IC ( P < 0.05). A mismatch between mucosal aspect (necrosis) and serous (normal) was observed in 13 patients (46 %). Risk factors for colectomy in univariate analysis were aortic aneurysm surgery, hemodynamic instability, no colic enhancement on CT scan, and endoscopic grade 3. Risk factors for mortality in multivariate analysis were hemodynamic instability, colectomy, and Charlson score > 5 ( P < 0.05). Conclusions This study suggests a low impact of endoscopy on surgical decision making. Hemodynamic instability was the first indication for colectomy. A discrepancy between endoscopic mucosal (necrosis) and surgical serous (normal) aspects was frequently noted.
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Affiliation(s)
- Diane Lorenzo
- Department of Gastroenterology, Aix Marseille University – APHM – Hôpital Nord, Marseille, France
| | - Marc Barthet
- Department of Gastroenterology, Aix Marseille University – APHM – Hôpital Nord, Marseille, France
| | - Mélanie Serrero
- Department of Gastroenterology, Aix Marseille University – APHM – Hôpital Nord, Marseille, France
| | - Laura Beyer
- Department of Visceral Surgery, Aix Marseille University – APHM – Hôpital Nord, Marseille, France
| | - Stéphane Berdah
- Department of Visceral Surgery, Aix Marseille University – APHM – Hôpital Nord, Marseille, France
| | - David Birnbaum
- Department of Visceral Surgery, Aix Marseille University – APHM – Hôpital Nord, Marseille, France
| | - Véronique Vitton
- Department of Gastroenterology, Aix Marseille University – APHM – Hôpital Nord, Marseille, France
| | - Jean Michel Gonzalez
- Department of Gastroenterology, Aix Marseille University – APHM – Hôpital Nord, Marseille, France
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Shin MY, Moon HS, Kwon IS, Park JH, Kim JS, Kang SH, Lee ES, Kim SH, Sung JK, Lee BS, Jeong HY. Development and Validation of a Risk Scoring Model for Early Prediction of Severe Colon Ischemia. Dig Dis Sci 2021; 66:3993-4000. [PMID: 33242157 DOI: 10.1007/s10620-020-06717-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 11/10/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND Colon ischemia (CI) is injury to the intestines secondary to insufficient blood flow. Its clinical severity can range from mild to life-threatening. AIMS To investigate predictive risk factors for CI and propose a scoring model for severe outcomes. METHODS We retrospectively analyzed the medical records of patients admitted to Chungnam National University Hospital from January 2010 to December 2018. CI was defined as severe when patients required surgery immediately or after initial conservative management, death occurred after hospitalization, or symptoms persisted after 2 weeks. By controlling for possible confounders from the logistic regression analysis, we obtained a new risk scoring model for the early prediction of severe CI. Furthermore, using the area under the receiver operating characteristics curve (AUROC), we assessed the accuracy of the model. RESULTS A total of 274 patients endoscopically diagnosed with CI were included, of whom 181 had severe CI. In the multivariate analysis, tachycardia, elevated C-reactive protein, Favier endoscopic classification stage ≥ 2, and history of hypertension were independently and significantly associated with severe CI. The AUROC of the model was 0.749. CONCLUSIONS This risk scoring model based on the presence of tachycardia, elevated C-reactive protein level, unfavorable endoscopic findings by Favier's classification, and the history of hypertension could be used to predict severe CI outcomes at an early stage.
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Affiliation(s)
- Min Young Shin
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Hee Seok Moon
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea.
| | - In Sun Kwon
- Clinical Trials Center, Chungnam National University Hospital, Daejeon, South Korea
| | - Jae Ho Park
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Ju Seok Kim
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Sun Hyung Kang
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Eaum Seok Lee
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Seok Hyun Kim
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Jae Kyu Sung
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Byung Seok Lee
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
| | - Hyun Yong Jeong
- Division of Gastroenterology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea
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Chronic obstructive pulmonary disease is associated with worse outcomes in ischemic colitis: a nationwide retrospective study. Int J Colorectal Dis 2021; 36:2455-2461. [PMID: 33987734 DOI: 10.1007/s00384-021-03935-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ischemic colitis (IC) occurs when the blood supply of the large intestine becomes compromised. Several cardiovascular conditions, such as coronary artery disease, congestive heart failure, and atrial fibrillation, are well-established risk factors for the development of IC. The effects of pulmonary conditions, namely chronic obstructive pulmonary disease (COPD), on IC have not been well studied. AIMS Our aim was to elucidate if the presence of COPD worsened outcomes in patients with IC. METHODS Retrospective analysis of patients hospitalized with IC in 2016 was evaluated using the National Inpatient Sample database. Baseline demographic data, length of hospital stay (LOS), total hospital cost/charge, rates of colectomy, and in-hospital mortality were extracted from the database. Categorical variables were compared using the chi-square test and continuous variables were compared using the t-test. RESULTS A total of 25,035 patients with IC were identified while 4482 of these patients also had COPD. We found that IC patients with COPD had a longer LOS (5.8 days vs 4.4 days; P<0.01), higher total hospital charge ($56,682 vs $42,365; P<0.01), higher total hospital cost ($13,603 vs $10,238; P<0.01), higher mortality rate (6.5% vs 3.1%; P<0.01), and higher colectomy rate (5.1% vs 3.7%; P<0.01). CONCLUSIONS The presence of COPD portends poor outcomes in patients with IC. This was evidenced by increased risk of death and increased risk of undergoing colectomy. Given these findings, patients with COPD warrant closer observation. We advocate that COPD be considered as part of the risk assessment of patients with acute IC who need surgical intervention.
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Aliyev V, Goksel S, Asoglu O. Acute Ischemic Gangrene of the Rectosigmoid Colon in a Patient With Rectal Cancer in the "Watch-and-Wait" Protocol. Cureus 2021; 13:e14998. [PMID: 33996340 PMCID: PMC8117261 DOI: 10.7759/cureus.14998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Acute rectal ischemia is a rare entity because the rectum has abundant blood supply from the inferior mesenteric, internal iliac, internal pudendal, and marginal artery with rich collaterals. We present a case of an acute ischemic proctosigmoiditis with a history of rectal cancer who completely recovered after total neoadjuvant treatment and was in the “watch-and-wait” protocol. Urgent laparoscopic low anterior resection and protective ileostomy were performed. Causes of acute rectosigmoid ischemia include old age, diabetes, atherosclerosis, previous aortic surgery due to aneurysm, vasculitis, and radiotherapy. Ischemia may be present as only involving the mucosa, which can be managed conservatively, but full-thickness necrosis requires urgent surgical intervention. Endoscopic examination is the gold standard in initial diagnosis. Ischemic gangrene of the rectosigmoid colon is a rare condition and can be life-threatening unless an urgent surgical intervention is performed.
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Affiliation(s)
- Vusal Aliyev
- General and Colorectal Surgery, Maslak Acibadem Hospital, Istanbul, TUR
| | - Suha Goksel
- Pathology, Maslak Acibadem Hospital, Istanbul, TUR
| | - Oktar Asoglu
- General and Colorectal Surgery, Bogazici Academy for Clinical Sciences, Istanbul, TUR
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Ito T, Takasaki K, Takada M, Tomioka A. Ischaemic colitis diagnosed by sigmoidoscopy during pregnancy. BMJ Case Rep 2021; 14:e239975. [PMID: 33947673 PMCID: PMC8098988 DOI: 10.1136/bcr-2020-239975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 11/03/2022] Open
Abstract
A 21-year-old woman visited out hospital for lower abdominal pain and bloody diarrhoea at 19 weeks of pregnancy. Endoscopic findings revealed longitudinal ulcerations with hyperaemia and oedema in the sigmoid colon. These findings and clinical presentation confirmed the diagnosis of ischaemic colitis. Conservative treatment, including fasting and intravenous hydration, was administered, and the patient made a good recovery. After discharge, there was no recurrence during pregnancy and postpartum period. It is important to make early diagnosis and treatment, and multidisciplinary teamwork between obstetricians, gastroenterologist and endoscopist is required.
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Affiliation(s)
- Tsubasa Ito
- Department of Obstetrics and Gynecology, Self Defense Force Sapporo Hospital, Sapporo, Japan
| | - Kazuki Takasaki
- Department of Obstetrics and Gynecology, Self Defense Force Sapporo Hospital, Sapporo, Japan
| | - Minori Takada
- Department of Obstetrics and Gynecology, Self Defense Force Sapporo Hospital, Sapporo, Japan
| | - Akira Tomioka
- Department of Gastroenterology, National Defense Medical College, Tokorozawa, Japan
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Wongtrakul W, Charoenngnam N, Ungprasert P. The correlation between heart failure and the risk of ischemic colitis: a systematic review and meta-analysis. Ann Gastroenterol 2021; 34:378-384. [PMID: 33948063 PMCID: PMC8079878 DOI: 10.20524/aog.2021.0596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/30/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Ischemic colitis is a relatively common gastrointestinal disease caused by hypoperfusion of the colon. Recently, studies have suggested an association between heart failure (HF) and ischemic colitis, even though the magnitude of the reported association varied considerably across the studies. This systematic review and meta-analysis were performed to comprehensively explore whether patients with HF are at a higher risk of ischemic colitis compared with individuals without HF by combining the results of all available observational studies. METHODS Systematic literature review was performed using EMBASE, MEDLINE and Google Scholar database up to May 2020. Eligible studies could be any observational ones that evaluated whether patients with HF have a higher risk of ischemic colitis than individuals without HF. Point estimates and standard errors from each eligible study were combined together using the generic inverse variance method of DerSimonian and Laird. RESULTS The systematic review identified 7 case-control studies and 1 cross-sectional study. The pooled analysis found that patients with HF had a significantly higher risk of ischemic colitis with the pooled odds ratio of 3.42 (95% confidence interval 1.49-7.82; I2 96%). Funnel plot was relatively symmetric and was not suggestive of presence of publication bias. CONCLUSION A significantly increased risk of ischemic colitis among patients with HF was demonstrated in this systematic review and meta-analysis.
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Affiliation(s)
- Wasit Wongtrakul
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand (Wasit Wongtrakul)
| | - Nipith Charoenngnam
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand (Nipith Charoenngnam)
| | - Patompong Ungprasert
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio, USA (Patompong Ungprasert)
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18
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Willemsen SI, Ten Berge MG, Statius van Eps RG, Veger HTC, van Overhagen H, van Dijk LC, Putter H, Wever JJ. Nationwide Study to Predict Colonic Ischemia after Abdominal Aortic Aneurysm Repair in The Netherlands. Ann Vasc Surg 2020; 73:407-416. [PMID: 33383137 DOI: 10.1016/j.avsg.2020.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Colonic ischemia remains a severe complication after abdominal aortic aneurysm (AAA) repair and is associated with a high mortality. With open repair being one of the main risk factors of colonic ischemia, deciding between endovascular or open aneurysm repair should be based on tailor-made medicine. This study aims to identify high-risk patients of colonic ischemia, a risk that can be taken into account while deciding on AAA treatment strategy. METHODS A nationwide population-based cohort study of 9,433 patients who underwent an AAA operation between 2014 and 2016 was conducted. Potential risk factors were determined by reviewing prior studies and univariate analysis. With logistic regression analysis, independent predictors of intestinal ischemia were established. These variables were used to form a prediction model. RESULTS Intestinal ischemia occurred in 267 patients (2.8%). Occurrence of intestinal ischemia was seen significantly more in open repair versus endovascular aneurysm repair (7.6% vs. 0.9%; P < 0.001). This difference remained significant after stratification by urgency of the procedure, in both intact open (4.2% vs. 0.4%; P < 0.001) and ruptured open repair (15.0% vs. 6.2%); P < 0.001). Rupture of the AAA was the most important predictor of developing intestinal ischemia (odds ratio [OR], 5.9, 95% confidence interval [CI] 4.4-8.0), followed by having a suprarenal AAA (OR 3.4; CI 1.1-10.6). Associated procedural factors were open repair (OR 2.8; 95% CI 1.9-4.2), blood loss >1L (OR 3.6; 95% CI 1.7-7.5), and prolonged operating time (OR 2.0; 95% CI 1.4-2.8). Patient characteristics included having peripheral arterial disease (OR 2.4; 95% CI 1.3-4.4), female gender (OR 1.7; 95% CI 1.2-2.4), renal insufficiency (OR 1.7; 1.3-2.2), and pulmonary history (OR 1.6; 95% CI 1.2-2.2). Age <68 years proved to be a protective factor (OR 0.5; 95% CI 0.4-0.8). Associated mortality was higher in patients with intestinal ischemia versus patients without (50.6% vs. 5.1%, P < 0.001). Each predictor was given a score between 1 and 4. Patients with a score of ≥10 proved to be at high risk. A prediction model with an excellent AUC = 0.873 (95% CI 0.855-0.892) could be formed. CONCLUSIONS One of the main risk factors is open repair. Several other risk factors can contribute to developing colonic ischemia after AAA repair. The proposed prediction model can be used to identify patients at high risk for developing colonic ischemia. With the current trend in AAA repair leaning toward open repair for better long-term results, our prediction model allows a better informed decision can be made in AAA treatment strategy.
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Affiliation(s)
| | | | | | | | - Hans van Overhagen
- Department of Interventional Radiology, Haga Teaching Hospital, The Hague, the Netherlands
| | - Lukas Carolus van Dijk
- Department of Interventional Radiology, Haga Teaching Hospital, The Hague, the Netherlands
| | - Hein Putter
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan Jacob Wever
- Department of Vascular Surgery, Haga Teaching Hospital, The Hague, the Netherlands
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Moore M, Feakins RM, Lauwers GY. Non-neoplastic colorectal disease biopsies: evaluation and differential diagnosis. J Clin Pathol 2020; 73:783-792. [PMID: 32737191 DOI: 10.1136/jclinpath-2020-206794] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 05/30/2020] [Indexed: 12/11/2022]
Abstract
A wide variety of non-neoplastic conditions may be encountered on colorectal biopsy encompassing idiopathic, infectious, vascular and immune-mediated aetiologies. Although interpretation of such biopsies may be challenging, appreciation of the dominant pattern of injury and subsequent host response may allow for a more focused histological diagnosis in the correct clinical and endoscopic setting. This article aims to provide a systematic, methodical approach to the assessment of such biopsies, concentrating mainly on diagnoses other than inflammatory bowel disease.
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Affiliation(s)
- Michelle Moore
- Department of Cellular Pathology, Belfast Health and Social Care Trust, Belfast, UK
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20
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Abe Y, Tsukano S, Izumita Y, Yamanaka T. Hemorrhagic colitis can be a life-threatening side effect of oseltamivir. Pediatr Int 2020; 62:634-635. [PMID: 32304123 DOI: 10.1111/ped.14138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/01/2019] [Accepted: 12/23/2019] [Indexed: 02/04/2023]
Affiliation(s)
- Yuki Abe
- Department of Pediatrics, Niigata City General Hospital, Niigata, Japan
| | - Shinya Tsukano
- Department of Pediatrics, Niigata City General Hospital, Niigata, Japan
| | - Yukie Izumita
- Department of Pediatrics, Niigata City General Hospital, Niigata, Japan
| | - Takayuki Yamanaka
- Department of Pediatrics, Niigata City General Hospital, Niigata, Japan
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Polydeoxyribonucleotide Exerts Therapeutic Effect by Increasing VEGF and Inhibiting Inflammatory Cytokines in Ischemic Colitis Rats. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2169083. [PMID: 32149087 PMCID: PMC7056995 DOI: 10.1155/2020/2169083] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 01/14/2020] [Accepted: 01/24/2020] [Indexed: 12/11/2022]
Abstract
Ischemic colitis is resulted from an inadequate blood supply to a segment or entire colon. Polydeoxyribonucleotide (PDRN), extracted from salmon sperm, has been reported to exert anti-inflammatory and anti-ischemic effects through the adenosine A2A receptor (A2AR). We investigated whether PDRN possesses therapeutic effectiveness on ischemic colitis rats. Ischemic colitis was induced by selective devascularization. The skin temperature on the ischemic colitis-induced region was determined. To assess the colonic damage score and collagen deposition, colonic tissue sections were stained with hematoxylin and eosin (H&E), and Masson trichrome staining was performed. Western blot analysis for A2AR, vascular endothelial growth factor (VEGF), cyclooxygenase-2 (COX-2), tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and IL-6, Bax, Bcl-2, and extracellular signal-regulated kinase 1/2 (ERK1/2) was performed. Skin temperature was increased and mucosal damage and collagen deposition were observed in the affected colonic tissues in the ischemic colitis rats. Expressions of inflammatory cytokines (TNF-α, IL-1β, and IL-6) and inflammatory mediator (COX-2) were upregulated in the ischemic colitis rats. Apoptosis was increased by decreasing the ratio of Bcl-2 to Bax and by suppressing the phosphorylated form of ERK1/2 expression in the ischemic colitis rats. Treatment with PDRN alleviated mucosal damage reduced the expressions of inflammatory cytokines and COX-2 and inhibited apoptosis in the ischemic colitis rats. PDRN treatment more enhanced the expressions of A2AR and VEGF in the ischemic colitis rats. PDRN showed therapeutic effectiveness on ischemic colitis by increasing VEGF expression and inhibiting inflammatory cytokines and COX-2 through enhancing A2AR expression.
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Patil P, Panarelli NC. Educational Case: Ischemic Disorders of the Gut in Adult Patients. Acad Pathol 2019; 6:2374289519888709. [PMID: 31799383 PMCID: PMC6873276 DOI: 10.1177/2374289519888709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 09/02/2019] [Accepted: 10/13/2019] [Indexed: 12/14/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see http://journals.sagepub.com/doi/10.1177/2374289517715040. 1.
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Affiliation(s)
- Priyanka Patil
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nicole C Panarelli
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA
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24
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McDonald NM, Piovezani Ramos G, Sweetser S. 60-Year-Old Man With Syncope, Abdominal Pain, and Hematochezia. Mayo Clin Proc 2019; 94:1883-1887. [PMID: 31400905 DOI: 10.1016/j.mayocp.2019.01.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/26/2018] [Accepted: 01/08/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Nicholas M McDonald
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | | | - Seth Sweetser
- Advisor to Residents and Consultant in Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
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Akanbi O, Adejumo AC. Early Endoscopy Is Associated with Better Clinical Outcomes in Patients Hospitalized with Ischemic Bowel Disease. Dig Dis Sci 2019; 64:2467-2477. [PMID: 30929115 DOI: 10.1007/s10620-019-05598-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 03/21/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Providing diagnostic and therapeutic interventions, lower gastrointestinal endoscopy is a salient investigative modality for ischemic bowel disease (IB). As studies on the role of endoscopic timing on the outcomes of IB are lacking, we sought to clarify this association. METHODS After identifying 18-to-90-year-old patients with a primary diagnosis of IB from the 2012-2014 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample, we grouped them based on timing of endoscopy into three: early (n = 9268), late (n = 3515), and no endoscopy (n = 18,452). We explored the determinants of receiving early endoscopy, the impact of endoscopic timing on outcomes (mortality and 13 others), and the impact of the type of endoscopy (colonoscopy vs. sigmoidoscopy) on these outcomes among the early group (SAS 9.4). RESULTS Less likely to receive early endoscopy were Blacks compared to Whites (adjusted odds ratio [aOR] 0.81 95% CI [0.70-0.94]), and individuals on Medicaid, Medicare, and uninsured compared to the privately insured group (aOR 0.80 [0.71-0.91], 0.70 [0.58-0.84], and 0.68 [0.56-0.83]). Compared to the late and no endoscopy groups, patients with early endoscopy had less mortality (aOR 0.53 [0.35-0.80] and 0.09 [0.07-0.12]), shorter length of stay (LOS, 4.64 [4.43-4.87] days vs. 8.87 [8.40-9.37] and 6.62 [6.52-7.13] days), lower total hospital cost (THC, $41,055 [$37,995-$44,361] vs. $72,598 [$66,768-$78,937] and $68,737 [$64,028-$73,793]), and better outcomes. Similarly, among those who received early endoscopy, colonoscopy had better outcomes than sigmoidoscopy for mortality, THC, LOS, and adverse events. CONCLUSION Early endoscopy, especially colonoscopy, is associated with better clinical outcomes and decreased healthcare utilization in IB. Unfortunately, there are disparities against Blacks, and non-privately insured individuals in receiving early endoscopy.
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Affiliation(s)
- Olalekan Akanbi
- Division of Hospital Medicine, Department of Medicine, University of Kentucky College of Medicine, Lexington, KY, USA.
| | - Adeyinka Charles Adejumo
- Department of Medicine, North Shore Medical Center, Salem, MA, USA
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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Brechmann T, Günther K, Neid M, Tannapfel A, Schmiegel W. Phenotype of histologically suspected drug-induced colitis; results of a comparative, retrospective cohort study. Scand J Gastroenterol 2019; 54:855-862. [PMID: 31215277 DOI: 10.1080/00365521.2019.1630674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background/aims: Drug-induced colitis (DiC) is a rarely reported form of colonopathy and data about the clinical and endoscopic characteristics are scarce. The aim was to investigate the phenotype of DiC. Methods: Patients in a retrospective case control study were assigned to either DiC or one of two age- and gender-matched control groups (non-inflammatory controls and inflammatory colitis from other causes) based on histopathological findings. Patients' basic characteristics, symptoms, biochemical results and endoscopic appearance were collected. Statistical analysis included ANOVA, the chi-squared test and two-tailed t-test. Results: A total of 211 patients with DiC were included (97 males, age 62.1 ± 16.1 years, BMI 25.9 ± 6.1 kg m-2). In comparison to both control groups, DiC patients presented higher ASA and ECOG-scores and more particularly atherosclerotic comorbidities. The most abundant symptoms were abdominal pain (51.8%), diarrhoea (50.7%) and haematochezia (24.3%). The red blood cell count demarcated anaemia (12.7 ± 2.3 mg/dl) and C-reactive protein was slightly elevated (2.7 ± 5.2 mg/dl). The endoscopic features included erythema (46.9%), oedema (29.9%), erosions (29.9%) and ulcers (14.7%). The inflammation affected the rectum rarely (2.4%) but affected the rest of the colon without predilection in a segmental manner (p<.05). The severity of DiC was mostly mild (85.7%). Conclusions: The phenotype of DiC differs slightly from that of colitis from other causes. Taking the clinical features into account might help to confirm drug-induced aetiology once the pathologist has raised the suspicion.
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Affiliation(s)
- Thorsten Brechmann
- Department of Gastroenterology and Hepatology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH , Bochum , Germany
| | - Katharina Günther
- Department of Gastroenterology and Hepatology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH , Bochum , Germany
| | - Matthias Neid
- Institute of Pathology, Ruhr-University , Bochum , Germany
| | | | - Wolff Schmiegel
- Department of Gastroenterology and Hepatology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH , Bochum , Germany
- Department of Internal Medicine, University Hospital Knappschaftskrankenhaus , Bochum , Germany
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Mass-Forming Ischemic Colitis: A Potential Mimicker of Malignancy. Case Rep Pathol 2019; 2019:8927872. [PMID: 31007961 PMCID: PMC6441522 DOI: 10.1155/2019/8927872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 02/25/2019] [Indexed: 12/30/2022] Open
Abstract
Ischemic colitis (IC) results from reduced colonic vascular perfusion, accounting for 50-60% of all gastrointestinal ischemic episodes. IC leads to mucosal damage with clinical symptom severity developing based on the duration and extent of colonic injury. In rare cases IC may form a mass-like lesion mimicking malignancy. Here we present the case of a 55-year-old female with hematochezia and diarrhea, who on workup was found to have a mass-like lesion at the ileocecal valve. Multiple biopsies demonstrated ischemic change and mucosal injury without evidence of dysplasia or carcinoma. Two months later on follow-up imaging, after supportive treatment the lesion was completely resolved. It is critical for gastroenterologists and pathologists to be aware of this variant of IC to avoid unnecessary surgical procedures and treatment of patients.
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Jia LL, Zhang LF. Clinical characteristics of ischemic colitis: Analysis of 50 cases. Shijie Huaren Xiaohua Zazhi 2019; 27:311-317. [DOI: 10.11569/wcjd.v27.i5.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ischemic colitis (IC), the most common type of ischemic bowel disease, is one of the most common causes of lower gastrointestinal bleeding. The incidence of IC is increasing year by year, but its clinical diagnosis is difficult. Therefore, it is of great significance to investigate the clinical characteristics of IC.
AIM To investigate the clinical characteristics of IC to improve its early diagnosis.
METHODS Clinical data of 50 patients with IC diagnosed at the First Affiliated Hospital of Zhengzhou University from January 2012 to August 2018 were retrospective analyzed.
RESULTS A total of 50 patients with IC were included with a mean age of 61.8 years ± 12.9 years and a female predominance (70.0%). The most common symptoms were abdominal pain, hematochezia, and diarrhea. The majority of patients had comorbidities of hypertension, coronary artery disease, diabetes mellitus, hyperlipidemia, etc. Non-steroidal antiinflammatory drugs, antihypertensive drugs, and statins were the most commonly used concomitant medications. Three cases were dignosed with idiopathic thrombocytopenic purpura at the same time. Colonic mucosal lesions presented regional distribution under colonoscope, with manifestations of erosions, hyperemia, edema, and ulcerations, and some were characterized by lumen stricture. Chronic inflammation was the most common pathological finding. All the patients were discharged after medical treatment. We followed these patient for 2 mo to 72 mo, of whom one died and six had a relapse.
CONCLUSION IC has non-specific symptoms and changes quickly, and identifing the underlying risk factors of IC and early complete colonoscopy (within 48 h) together with biopsy are important to improve the early diagnosis of IC.
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Affiliation(s)
- Lu-Lu Jia
- Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Lian-Feng Zhang
- Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
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29
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Brechmann T, Günther K, Neid M, Schmiegel W, Tannapfel A. Triggers of histologically suspected drug-induced colitis. World J Gastroenterol 2019; 25:967-979. [PMID: 30833802 PMCID: PMC6397729 DOI: 10.3748/wjg.v25.i8.967] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/22/2019] [Accepted: 01/26/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Drug toxicity is a common and even serious problem in the gastrointestinal tract that is thought to be caused by a broad spectrum of agents. Although withdrawal of the causative agent would cure the disease knowledge is scarce and mostly derives from case reports and series.
AIM To investigate potential triggers of drug-induced colitis (DiC).
METHODS We conducted a retrospective, observational case control study. Patients were assigned to DiC or one of two age- and gender-matched control groups (non-inflammatory controls and inflammatory colitis of another cause) based on histopathological findings. Histopathology was reassessed in a subset of patients (28 DiC with atherosclerosis, DiC without atherosclerosis and ischaemic colitis each) for validation purposes. Medical history was collected from the electronic database and patient records. Statistical analysis included chi-squared test, t-test, logistic and multivariate regression models.
RESULTS Drug-induced colitis was detected in 211 endoscopically sampled biopsy specimens of the colon mucosa (7% of all screened colonoscopic biopsy samples); a total of 633 patients were included equally matched throughout the three groups (291 males, mean age: 62.1 ± 16.1 years). In the univariate analysis, DiC was associated with diuretics, dihydropyridines, glycosides, ASS, platelet aggregation inhibitors, nonsteroidal anti-inflammatory drugs (NSAIDs), statins and fibrates, and with atherosclerosis, particularly coronary heart disease, and hyperlipoproteinaemia. Echocardiographic parameters did not show substantial differences. In the multivariate analysis only fibrates [odds ratio (OR) = 9.1], NSAIDs (OR = 6.7) and atherosclerosis (OR = 2.1) proved to be associated with DiC. Both DiC reassessment groups presented milder inflammation than ischaemic colitis. The DiC patients with atherosclerosis exhibited histological features from both DiC without atherosclerosis and ischaemic colitis.
CONCLUSION Several drugs indicated for the treatment of cardiovascular and related diseases are associated with DiC. Atherosclerosis and microcirculatory disturbances seem to play an important pathogenetic role.
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Affiliation(s)
- Thorsten Brechmann
- Department of Gastroenterology and Hepatology, Ruhr-University Bochum, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH, Bochum 44789, Germany
| | - Katharina Günther
- Department of Gastroenterology and Hepatology, Ruhr-University Bochum, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH, Bochum 44789, Germany
| | - Matthias Neid
- Institute of Pathology, Ruhr-University Bochum, Bochum 44789, Germany
| | - Wolff Schmiegel
- Department of Gastroenterology and Hepatology, Ruhr-University Bochum, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH, Bochum 44789, Germany
- Department of Internal Medicine, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum 44892, Germany
| | - Andrea Tannapfel
- Institute of Pathology, Ruhr-University Bochum, Bochum 44789, Germany
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30
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Adejumo AC, Akanbi O, Pani L. Among inpatients, ischemic bowel disease predisposes to Clostridium difficile infection with concomitant higher mortality and worse outcomes. Eur J Gastroenterol Hepatol 2019; 31:109-115. [PMID: 30513074 DOI: 10.1097/meg.0000000000001273] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Clinical conditions resulting in hypoxia, hypoperfusion, anaerobic milieu within the gut, and intestinal epithelial breakdown, such as seen in heart failure, precipitates Clostridium difficile infection (CDI). Given that ischemic bowel disease (IB) typically results in similar changes within the gut, we investigated the relationship between CDI and IB, and the impact of CDI on the clinical outcomes of IB. PATIENTS AND METHODS We initially performed a cross-sectional analysis on the 2014 Healthcare Cost and Utilization Project - Nationwide Inpatient Sample (NIS) patient's discharge records of ages 18 years and older, by estimating the crude and adjusted odds ratio (aOR) of CDI and IB as the outcome and predictor respectively. We then pooled data from the 2012-2014 NIS, identified, and compared mortality (and 15 other outcomes) between three groups: IB+CDI, IB-alone, and CDI-alone (Statistical Analysis System 9.4). RESULTS In the 2014 NIS, records with IB (n=27 609), had higher rate and odds of CDI [3.95 vs. 1.17%, aOR: 1.89 (1.77-2.02)] than records without IB (n=5 879 943). The 2012-2014 NIS contained 1105 IB+CDI, 30 960 IB-alone, and 60 758 CDI-alone groups. IB+CDI had higher mortality [aOR: 1.44 (1.11-1.86)], length of stay [9.59 (9.03-10.20) vs. 6.12 (5.99-6.26) days], cost [$93 257 (82 892-104 919) vs. $63 257 (61 029-65 567)], unfavorable discharge disposition [aOR: 2.24 (1.91-2.64)] and poorer results across most of the other outcomes than IB-alone. Comparable results were found for IB+CDI versus CDI-alone. CONCLUSION IB is a risk factor for CDI in hospitals. CDI is associated with higher mortality, longer length of stay, higher cost, unfavorable discharge, and many other poorer health outcomes in patients with IB.
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Affiliation(s)
- Adeyinka C Adejumo
- Department of Medicine, North Shore Medical Center, Salem
- Department of Medicine, University of Massachusetts Medical School, Worcester
- Department of Medicine, Tufts University Medical School, Boston, Massachusetts
| | - Olalekan Akanbi
- Division of Hospital Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Lydie Pani
- Department of Medicine, North Shore Medical Center, Salem
- Department of Medicine, Tufts University Medical School, Boston, Massachusetts
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31
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Fenster M, Feuerstadt P, Brandt LJ, Mansoor MS, Huisman T, Aroniadis OC. Real-world multicentre experience of the pathological features of colonic ischaemia and their relationship to symptom duration, disease distribution and clinical outcome. Colorectal Dis 2018; 20:1132-1141. [PMID: 29969179 DOI: 10.1111/codi.14323] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 06/06/2018] [Indexed: 02/08/2023]
Abstract
AIM To determine the pathological features of colonic ischaemia (CI) and their relationship to symptom duration, disease distribution and clinical outcome in a real-world, clinical setting. METHOD A retrospective, multicentre chart review was performed in patients diagnosed with CI at Montefiore Medical Center (January 2005 to July 2015), and Yale-New Haven Hospital (January 2005 to June 2010). Patients were included if clinical presentation, colonoscopic findings and colonic pathology were all consistent with CI. RESULTS Six hundred and sixteen patients with pathologically proven CI were included. Common pathological findings included inflammation (51.1%), ulceration (38.2%), fibrosis (26.0%) and necrosis (20.4%). Infarction and ghost cells were seen in 1.6% and 0.2% of cases, respectively. There was a significant relationship between symptom duration and hyalinization of the lamina propria (P = 0.05) and cryptitis/crypt abscesses (P = 0.01). Patients with isolated right CI (IRCI) were more likely than patients with isolated left CI (ILCI) to exhibit necrosis (P < 0.01), cryptitis/crypt abscess (P < 0.01) and inflammation (P = 0.03). Patients with poor outcomes were more likely to exhibit necrosis (P < 0.01) and capillary fibrin thrombi (P < 0.01) and less likely to exhibit fibrosis (P < 0.01) and epithelial changes (P < 0.01). CONCLUSION CI is accompanied by a broad spectrum of pathological findings. The traditional pathognomonic findings of CI are rare and cannot be relied upon to exclude the diagnosis. Patients with IRCI and/or poor outcomes were more likely to have pathological findings of necrosis than patients who had ILCI and/or nonpoor outcomes.
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Affiliation(s)
- M Fenster
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - P Feuerstadt
- Yale University School of Medicine, New Haven, Connecticut, USA
- Gastroenterology Center of Connecticut, Hamden, Connecticut, USA
| | - L J Brandt
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Division of Gastroenterology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - M S Mansoor
- Department of Internal Medicine, Yale-New Haven Hospital, New Haven, CT, USA
| | - T Huisman
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - O C Aroniadis
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
- Division of Gastroenterology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
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32
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Sickle cell disease is associated with higher mortality among patients hospitalized with ischemic bowel disease. Eur J Gastroenterol Hepatol 2018; 30:1027-1032. [PMID: 29957616 DOI: 10.1097/meg.0000000000001181] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Sickle cell disease (SCD) is the most common inheritable hematologic disorder in the USA and is associated with ischemic organ diseases. SCD-associated ischemic bowel disease is increasing being recognized, and studies on the hospitalization outcomes of such patients are limited. OBJECTIVE This study aimed to compare the inpatient outcomes of ischemic bowel disease among patients with SCD compared with patients without SCD. MATERIALS AND METHODS This is a case-control study using data from the National Inpatient Sample Database (2007-2014). We analyzed and compared outcomes between cases (ischemic bowel disease with SCD) and controls (ischemic bowel disease without SCD), matched in a 1 : 5 ratio. The primary outcome was in-hospital mortality, and the secondary outcomes were healthcare resource utilization including mechanical ventilation, hemodialysis, transfusion, length of stay, and hospital charges. RESULTS Of the 194 262 patients admitted with ischemic bowel disease, 98 had a diagnosis of SCD and were matched successfully to the controls. In multivariate analysis, patients with SCD had twice the mortality odds of those without (adjusted odds ratio=2.06, 95% confidence intervals: 1.13-3.74). They were more likely to require mechanical ventilation and blood transfusion, and to be discharged to secondary health facilities [1.68 (1.02-2.76), 3.32 (2.15-5.12), and 1.84 (1.02-3.35)]. Patients with SCD also had a higher frequency of pneumonia, acute respiratory failure, and hemodialysis for acute renal failure. There was no significant difference in the length of stay or the total hospital charge between the two groups. CONCLUSION In patients hospitalized with ischemic bowel disease, SCD is associated with significantly increased mortality and healthcare burden.
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33
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Fousekis F, Aggeli P, Gkogkos S, Christou P, Pappas-Gogos G. Rectal ischemia causes mass formation, masquerading as rectal cancer. Oxf Med Case Reports 2018; 2018:omy068. [PMID: 30159159 PMCID: PMC6109197 DOI: 10.1093/omcr/omy068] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 07/08/2018] [Accepted: 07/16/2018] [Indexed: 12/24/2022] Open
Abstract
Rectal ischemia rarely occurs because of the rich vascular supply of the rectum, while endoscopic presentation of ischemic colitis always is not distinct and can uncommonly mimic malignant neoplasm. We present a case of a rectal ischemia, which presented with haematochezia and proctoscopy revealed a large ulcerating mass, masquerading as rectal cancer and obstructed the lumen of rectum. However, histological examinations showed only features for ischemic colitis and no evidence for malignancy. The patient was treated conservatively and 10 days later, new endoscopy showed complete disappearance of ulcerated mass, and new biopsies confirmed the initial diagnosis. Awareness and early diagnosis of ‘mass forming’ entity of ischemic colitis is very essential in order to carry out appropriate treatment and avoid severe complications.
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Affiliation(s)
- Fotios Fousekis
- Department of Gastroenterology and Endoscopy Unit, Filiates General Hospital, Filiates 46300, Greece
- Correspondence address. Pargas 23B, Igoumenitsa 46100, Greece, Tel: +30-698-852-0072; E-mail:
| | - Panagiota Aggeli
- Department of Gastroenterology and Endoscopy Unit, Filiates General Hospital, Filiates 46300, Greece
| | - Spyridon Gkogkos
- Department of Surgery, Filiates General Hospital, Filiates 46300, Greece
| | - Panagiota Christou
- Department of Internal Medicine, Filiates General Hospital, Filiates 46300, Greece
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34
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Hunninghake J, Murray BP, Ferraro D, Gancayco J. Acute intestinal ischaemia from a portal vein thrombosis in a young female smoker on an oral contraceptive. BMJ Case Rep 2018; 2018:bcr-2018-225135. [PMID: 30077981 DOI: 10.1136/bcr-2018-225135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
We report the case of a 23-year-old woman who presented with bloody diarrhoea and multiple syncopal events. While the initial diagnosis clinically appeared to be inflammatory bowel disease, she was found to have a portal vein thrombosis (PVT) on MR cholangiopancreatography and acute intestinal ischaemia on colonic biopsy. The aetiology of this patient's PVT is attributed to her acquired prothrombotic state from an estrogen-containing contraceptive pill in conjunction with regular tobacco use. Extensive mesenteric venous thrombosis from an acute PVT has been shown to cause intestinal ischaemia, likely from venous obstruction and reflexive arterial constriction; however, the diagnosis is often delayed until surgery or autopsy. Our case report highlights this patient's clinical presentation, workup and treatment, as part of a review for the risk factors and guidelines recommendations for management of an acute PVT.
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Affiliation(s)
- John Hunninghake
- Department of Pulmonary and Critical Care, US Army Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Brian Patrick Murray
- Department of Emergency Medicine, US Army Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - David Ferraro
- Department of Pulmonary and Critical Care, US Army Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - John Gancayco
- Department of Gastroenterology, US Army Brooke Army Medical Center, Fort Sam Houston, Texas, USA
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Abstract
This review describes a systematic approach to the interpretation of colonic biopsy specimens of patients with acute colitis. Five main histologic patterns are discussed: acute colitis, focal active colitis, pseudomembranous colitis, hemorrhagic colitis, and ischemic colitis. For each pattern, the most common etiologic associations and their differential diagnoses are presented. Strategies based on histologic analysis and clinical considerations to differentiate acute from chronic colitides are discussed.
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Affiliation(s)
- Jose Jessurun
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine New York, Starr 1031 B, 1300 York Avenue, New York, NY 10065, USA.
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36
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Hsu CC, Chen PY, Lai CC. Thigh emphysema as the initial presentation of colon ischemia. Am J Emerg Med 2018; 36:526.e1-526.e3. [PMID: 29290506 DOI: 10.1016/j.ajem.2017.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/04/2017] [Accepted: 12/04/2017] [Indexed: 10/18/2022] Open
Abstract
The incidence of colon ischemia has increased in recent years, and is associated with high morbidity and mortality. The typical presentations of colon ischemia include abdominal pain, bloody diarrhea, and in severe case, ileus, fever and peritonitis. Here, we document a rare case of colon ischemia presenting with subcutaneous and intramuscular emphysema of the thigh. A 76-year-old woman presented to the emergency department for left thigh pain for three days. Physical examination revealed tenderness without obvious crepitus, erythema or swelling over the left groin area and a soft abdomen without tenderness. Plain abdominal film showed abnormal gas formation at the left thigh and chest film demonstrated subphrenic free air. Abdominal computer tomography found sigmoid perforation causing left retroperitoneal abscess, and subcutaneous and intramuscular emphysema over the left pelvic and thigh region. During operation, irreversible ischemia from the terminal ileum through the cecum to the sigmoid colon with gangrene and retroperitoneal abscess were found. Total colectomy with end ileostomy and peritoneal toilet were performed. However, massive bloody ascites from abdominal drainage developed on the 13th day of admission. She later passed away due to hemorrhagic shock. In conclusion, emphysema of the thigh may rarely be caused by an intestinal lesion, such as colon ischemia. Clinicians should be alert of these unusual presentations to find the hidden underlying etiologies.
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Affiliation(s)
- Chin-Chuan Hsu
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan.
| | - Ping-Yuan Chen
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chih-Cheng Lai
- Department of Intensive Care Medicine, Chi-Mei Medical Center, Liouying, Taiwan.
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37
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Aziz M, Pervez A, Fatima R, Bansal A. Pseudoephedrine Induced Ischemic Colitis: A Case Report and Review of Literature. Case Rep Gastrointest Med 2018; 2018:8761314. [PMID: 30050703 PMCID: PMC6046157 DOI: 10.1155/2018/8761314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 06/13/2018] [Indexed: 12/20/2022] Open
Abstract
Ischemic colitis due to medications is common, and a number of cases have been described with pseudoephedrine as the culprit agent. We present here an interesting case of a healthy female with no risk factors who developed pseudoephedrine induced ischemic colitis. This case serves to remind the healthcare providers about the utmost importance of obtaining a comprehensive history to aid with the diagnosis.
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Affiliation(s)
- Muhammad Aziz
- 1Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Asad Pervez
- 2Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Rawish Fatima
- 3Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Ajay Bansal
- 2Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, KS, USA
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38
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Levi M, Middeldorp S, van Mens T. Evolution of Factor V Leiden. Thromb Haemost 2017; 110:23-30. [DOI: 10.1160/th13-02-0115] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 04/13/2013] [Indexed: 01/01/2023]
Abstract
SummaryFactor V Leiden is a procoagulant mutation associated with venous and arterial thrombosis and pregnancy complications. Its high prevalence of 5% in Caucasians suggests that there are evolutionary benefits as well. Carriers are indeed reported to have various advantageous phenotypes related to haemostasis, inflammation and fertility: less acute blood loss; less menstrual blood loss; decreased risk of intracranial haemorrhage; milder phenotypes of haemophilia; higher survival in and lower susceptibility to severe sepsis; higher survival in acute respiratory distress syndrome; less severe diabetic nephropathy and higher fecundity in both men and women. Not all these associations come from high quality adequately powered studies and many have not been confirmed by further research. The evolutionary influence of the alleged associations varies and is difficult to establish, partly due to a shift over time in risk factors of the diseases concerned. For most of the phenotypes possible mechanistic explanations can be provided. The procoagulant phenotype and perhaps also certain pregnancy complications follow from activated protein C (APC) resistance. Elevated APC levels possibly mediate anti-inflammatory effects. Higher sperm counts and more successful embryo implantation seem to play a role in the increased fecundity.
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39
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Nikolic AL, Keck JO. Ischaemic colitis: uncertainty in diagnosis, pathophysiology and management. ANZ J Surg 2017; 88:278-283. [PMID: 29124893 DOI: 10.1111/ans.14237] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 07/26/2017] [Indexed: 12/16/2022]
Abstract
Ischaemic colitis is the most common form of gastrointestinal ischaemia, but may be confused with acute mesenteric ischaemia, inflammatory bowel disease or infectious colitis. This review article outlines the current classification, epidemiology and risk factors, as well as approaches about diagnosis and management to guide clinical practice. It also identifies areas for further research.
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Affiliation(s)
- Amanda L Nikolic
- Department of Colon and Rectal Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - James O Keck
- Department of Colon and Rectal Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
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40
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Yngvadottir Y, Karlsdottir BR, Hreinsson JP, Ragnarsson G, Mitev RUM, Jonasson JG, Möller PH, Björnsson ES. The incidence and outcome of ischemic colitis in a population-based setting. Scand J Gastroenterol 2017; 52:704-710. [PMID: 28276832 DOI: 10.1080/00365521.2017.1291718] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Population-based studies on patients with ischemic colitis (IC) are limited. We aimed to determine the incidence, risk factors and outcome of patients with IC. METHODS A retrospective nationwide study was conducted on adult patients with histologically confirmed IC in 2009-2013 in Iceland. IC patients were matched for age and gender with patients hospitalized with lower gastrointestinal bleeding. Data were collected on clinical presentation, comorbidities, smoking habits, management and outcome. RESULTS Eighty-nine patients, 61 (69%) females and mean age of 65 years (±17), fulfilled the predetermined criteria. Females were older than males, 68 years (±14) vs. 59 years (±20) (p = .0170). The mean cumulative incidence was 7.3 cases per 100,000 inhabitants. A total of 57 (64%) patients presented with abdominal pain, hematochezia and diarrhea. IC was localized in the left colon in 78 (88%) patients. Overall, 62 (70%) patients had cardiovascular disease vs. 53 (60%) of control group (NS) and 55 (62%) had a history of smoking vs. 53 (60%) in control group (NS). Ten (11%) patients required surgery and/or died within 30-days from hospital admission. At the end of follow-up, 7 (9%) patients had experienced recurrence of IC with an estimated 3-year recurrence rate of 15%. CONCLUSIONS IC is a common clinical phenomenon that affects a wide range of age groups, but is most prominent among elderly women. It typically presents with a clinical triad of abdominal pain, hematochezia and diarrhea. Most cases are mild and self-limiting with a good prognosis.
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Affiliation(s)
- Y Yngvadottir
- a Department of Internal Medicine, Division of Gastroenterology and Hepatology , The National University Hospital of Iceland , Reykjavik , Iceland
| | - B R Karlsdottir
- a Department of Internal Medicine, Division of Gastroenterology and Hepatology , The National University Hospital of Iceland , Reykjavik , Iceland
| | - J P Hreinsson
- a Department of Internal Medicine, Division of Gastroenterology and Hepatology , The National University Hospital of Iceland , Reykjavik , Iceland
| | - G Ragnarsson
- a Department of Internal Medicine, Division of Gastroenterology and Hepatology , The National University Hospital of Iceland , Reykjavik , Iceland
| | - R U M Mitev
- b Department of Pathology , The National University Hospital of Iceland , Reykjavik , Iceland
| | - J G Jonasson
- b Department of Pathology , The National University Hospital of Iceland , Reykjavik , Iceland
| | - P H Möller
- c Department of Surgery , The National University Hospital of Iceland , Reykjavik , Iceland
| | - E S Björnsson
- a Department of Internal Medicine, Division of Gastroenterology and Hepatology , The National University Hospital of Iceland , Reykjavik , Iceland
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Pérez S, Taléns-Visconti R, Rius-Pérez S, Finamor I, Sastre J. Redox signaling in the gastrointestinal tract. Free Radic Biol Med 2017; 104:75-103. [PMID: 28062361 DOI: 10.1016/j.freeradbiomed.2016.12.048] [Citation(s) in RCA: 176] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 12/20/2016] [Accepted: 12/31/2016] [Indexed: 12/16/2022]
Abstract
Redox signaling regulates physiological self-renewal, proliferation, migration and differentiation in gastrointestinal epithelium by modulating Wnt/β-catenin and Notch signaling pathways mainly through NADPH oxidases (NOXs). In the intestine, intracellular and extracellular thiol redox status modulates the proliferative potential of epithelial cells. Furthermore, commensal bacteria contribute to intestine epithelial homeostasis through NOX1- and dual oxidase 2-derived reactive oxygen species (ROS). The loss of redox homeostasis is involved in the pathogenesis and development of a wide diversity of gastrointestinal disorders, such as Barrett's esophagus, esophageal adenocarcinoma, peptic ulcer, gastric cancer, ischemic intestinal injury, celiac disease, inflammatory bowel disease and colorectal cancer. The overproduction of superoxide anion together with inactivation of superoxide dismutase are involved in the pathogenesis of Barrett's esophagus and its transformation to adenocarcinoma. In Helicobacter pylori-induced peptic ulcer, oxidative stress derived from the leukocyte infiltrate and NOX1 aggravates mucosal damage, especially in HspB+ strains that downregulate Nrf2. In celiac disease, oxidative stress mediates most of the cytotoxic effects induced by gluten peptides and increases transglutaminase levels, whereas nitrosative stress contributes to the impairment of tight junctions. Progression of inflammatory bowel disease relies on the balance between pro-inflammatory redox-sensitive pathways, such as NLRP3 inflammasome and NF-κB, and the adaptive up-regulation of Mn superoxide dismutase and glutathione peroxidase 2. In colorectal cancer, redox signaling exhibits two Janus faces: On the one hand, NOX1 up-regulation and derived hydrogen peroxide enhance Wnt/β-catenin and Notch proliferating pathways; on the other hand, ROS may disrupt tumor progression through different pro-apoptotic mechanisms. In conclusion, redox signaling plays a critical role in the physiology and pathophysiology of gastrointestinal tract.
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Affiliation(s)
- Salvador Pérez
- Department of Physiology, Faculty of Pharmacy, University of Valencia, Burjasot, 46100 Valencia, Spain
| | - Raquel Taléns-Visconti
- Department of Pharmacy and Pharmaceutical Technology and Parasitology, Faculty of Pharmacy, University of Valencia, Burjasot, 46100 Valencia, Spain
| | - Sergio Rius-Pérez
- Department of Physiology, Faculty of Pharmacy, University of Valencia, Burjasot, 46100 Valencia, Spain
| | - Isabela Finamor
- Department of Physiology, Faculty of Pharmacy, University of Valencia, Burjasot, 46100 Valencia, Spain
| | - Juan Sastre
- Department of Physiology, Faculty of Pharmacy, University of Valencia, Burjasot, 46100 Valencia, Spain.
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Ten Heggeler LB, van Dam LJH, Bijlsma A, Visschedijk MC, Geelkerken RH, Meijssen MAC, Kolkman JJ. Colon ischemia: Right-sided colon involvement has a different presentation, etiology and worse outcome. A large retrospective cohort study in histology proven patients. Best Pract Res Clin Gastroenterol 2017; 31:111-117. [PMID: 28395782 DOI: 10.1016/j.bpg.2016.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 12/04/2016] [Accepted: 12/17/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Colon ischemia (CI), is generally considered a non-occlusive mesenteric ischemia disorder that usually runs a benign course, but right-sided involvement (RCI) has been associated with worse outcome. The poor outcome of RCI has been associated with comorbidity, but more recently also with occlusions of the mesenteric arteries. We performed a retrospective analysis of a large cohort of CI-patients to assess differences in presentation, etiology, and comorbidity between right-sided colon ischemia (RCI) and non-right-sided colon ischemia (NRCI), and their relation to outcome. METHODS We performed a retrospective cohort study in two centers from 2000 to 2011 for CI and analyzed clinical presentation, etiology, treatment and outcome. Diagnosis was based on full colonoscopy and/or surgical findings and confirmed by histopathology. RESULTS 239 patients were included (mean age 69, 52% female). RCI was found in 48% and NRCI in 52%. Patients with NRCI presented more often with rectal bleeding (87% vs. 45%; p<0.001). In RCI more nausea (58% vs. 39%; p=0.013), weight loss (56% vs. 19%; p<0.001), paralytic ileus (32% vs. 18%; p=0.018) and peritoneal signs (27% vs. 7%; p<0.001) was observed compared to NRCI. The cause of CI was more often idiopathic in NRCI (46% vs. 26%; p=0.002); an occlusive cause was seen more often in RCI (26.3 vs 2.4%, p<0.0001). RCI patients had longer hospital stay (15 vs. 8 days, p<0.001), need for surgery (61% vs. 34%, p<0.001), and trend toward higher 30-day in-hospital mortality (20% vs. 12%, p=0.084). CONCLUSIONS RCI ischemia has different etiology, presentation, and outcome. The series shows a high proportion of - treatable - vessel occlusion. It reinforces the advice to perform CT angiography in RCI as means to improve its poor outcome.
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Affiliation(s)
- Lotte B Ten Heggeler
- Department of Gastroenterology, Medical Spectrum Twente, Enschede, The Netherlands
| | - Lisette J H van Dam
- Department of Gastroenterology, Medical Spectrum Twente, Enschede, The Netherlands; Department of Gastroenterology, Isala Clinics, Zwolle, The Netherlands
| | - Alderina Bijlsma
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands
| | - Marijn C Visschedijk
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert H Geelkerken
- Department of Vascular Surgery, Medical Spectrum Twente, Enschede, The Netherlands
| | | | - Jeroen J Kolkman
- Department of Gastroenterology, Medical Spectrum Twente, Enschede, The Netherlands; Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands.
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Abstract
PURPOSE OF REVIEW To provide an update on the epidemiology, pathophysiology, clinical presentation, and management of colonic ischemia. RECENT FINDINGS Formerly regarded as a rare cause of lower gastrointestinal hemorrhage, colonic ischemia is now recognized to be the most common manifestation of intestinal vascular compromise. In contrast to ischemic events in the small intestine wherein thrombotic and embolic events predominate, colonic ischemia typically results from a global reduction in blood flow to the colon and no occlusive lesion(s) are evident. Several risk factors for colonic ischemia have been identified and, together with an appropriate clinical presentation and patient demographics, create a context in which the clinician should have a high level of suspicion for its presence. Imaging with computerized tomography, in particular, may be highly supportive of the diagnosis, which where appropriate can be confirmed by colonoscopy and colonic biopsy. For most patients, management is supportive and noninterventional, and the prognosis for recurrence and survival are excellent. SUMMARY Colonic ischemia is a common cause of lower abdominal pain and hemorrhage among the elderly typically occurring in the aftermath of an event which led to hypoperfusion of the colon. For most affected individuals the ischemia is reversible and clinical course benign.
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Affiliation(s)
- Ayah Oglat
- Division of Gastroenterology and Hepatology, Lynda K and David M Underwood Center for Digestive Disorders, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas, USA
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Tsekov C, Loukova A, Gelev V. Successful selective arterial thrombolysis in patient with acute abdominal thromboembolism. Turk J Emerg Med 2016; 16:86-88. [PMID: 27896331 PMCID: PMC5121261 DOI: 10.1016/j.tjem.2015.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 03/10/2015] [Accepted: 03/18/2015] [Indexed: 11/29/2022] Open
Abstract
The paper reports successful thrombolysis conducted in 64 years old woman admitted to the clinic with clinical and angiographic data for acute surgical abdomen caused by acute tromboembolia of arteria mesenterica superior (AMS). The therapeutic approach required to undertake lifesaving decision on i.e. surgical vs. invasive treatment in conditions of emergency. Finally, it was decided to undertake invasive treatment with successful restoration of blood flow in the related artery. The patient was discharged from the clinic with considerable clinical improvement on the fifth day of her stay. The case report includes discussion on issues relating the consequence of the diagnostic and interventional procedures in such patients, opportunities for conducting emergency thrombolysis in acute embolia of AMS and preventive measures in patients with high tromboembolic risk.
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Affiliation(s)
- Christo Tsekov
- Division of General, Visceral and Emergency Surgery, Emergency Medicine Institute Pirogov, Sofia, Bulgaria
| | - Anelia Loukova
- Clinic of Toxicology, Emergency Medicine Institute Pirogov, Sofia, Bulgaria
| | - Valeri Gelev
- Clinic of Cardiology, Emergency Medicine Institute Pirogov, Sofia, Bulgaria
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Peng XL, Tian JY, Cao Q. Value of detection of serum ischemia-modified albumin in diagnosis of ischemic colitis. Shijie Huaren Xiaohua Zazhi 2016; 24:4004-4007. [DOI: 10.11569/wcjd.v24.i28.4004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the diagnostic value of serum ischemia-modified albumin for ischemic colitis in order to find a simple, economical and sensitive diagnostic method for this disease.
METHODS From July 2013 to April 2016, 60 cases of ischemic colitis were diagnosed by colonoscopy. Fifty-eight patients who were hospitalized during the same period but had a normal colonoscopy were included as a control group. After admission, blood serum ischemia modified albumin levels were measured. Statistical analysis was then used to analyze the value of serum ischemia modified albumin in early diagnosis of ischemic colitis.
RESULTS In 60 patients with ischemic colitis confirmed by colonoscopy, the average level of serum ischemia modified albumin was 12.75 mg/L ± 3.51 mg/L. In 58 patients in the control group, the average level of serum ischemia modified albumin was 0.14 mg/L ± 0.02 mg/L. There was a significant difference in serum ischemia modified albumin level between the two groups (P < 0.05).
CONCLUSION Serum ischemia modified albumin is significantly higher in patients with ischemic colitis than in controls, suggesting that early detection of ischemia modified albumin can be helpful for the early diagnosis of ischemic colitis.
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Sun D, Wang C, Yang L, Liu M, Chen F. The predictors of the severity of ischaemic colitis: a systematic review of 2823 patients from 22 studies. Colorectal Dis 2016; 18:949-958. [PMID: 27206727 DOI: 10.1111/codi.13389] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 02/29/2016] [Indexed: 12/12/2022]
Abstract
AIM The study reviews the literature related to ischaemic colitis (IC) as the evidence base to identify factors predicting severity. METHOD A systematic review of the literature was conducted on the predictors of the severity of IC. Severe IC or adverse outcome of IC was defined as a patient requiring surgery or who died. MEDLINE, Embase and Cochrane Library databases were searched from inception to 15 January 2015. Manual searches of reference lists from potentially relevant papers and meetings were also performed. RESULTS In all, 22 studies involving 2823 patients were identified; 19 were case series, two were case-control studies and one was a cohort study. The overall adverse outcome rate was 22.0% (620/2823). The prognostic predictors for surgery or mortality which were most frequently reported included right sided IC, peritonitis, shock or arterial hypotension (< 90 mmHg), male gender, tachycardia and lack of rectal bleeding. Thirteen studies relating to the right colon from which data could be extracted were further analysed. The right colon was involved in 277 cases, with an incidence of adverse outcomes of 48.4% (134/277), while in the non-right colonic involvement group the incidence was significantly lower at 12.1% (142/1175) (P = 0.000). CONCLUSION The incidence of adverse outcome in patients with IC remains high. Male gender, tachycardia, lack of rectal bleeding, peritonitis, shock or arterial hypotension (< 90 mmHg) and right sided IC are predictors of poor prognosis. Right-sided IC, shock or arterial hypotension (< 90 mmHg) and signs of peritonitis may be the most significant predictors of severity.
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Affiliation(s)
- D Sun
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - C Wang
- Department of Gastroenterology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - L Yang
- Department of Gastroenterology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - M Liu
- Department of Gastroenterology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China
| | - F Chen
- Department of Gastroenterology, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China.
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Choi SR, Jee SR, Song GA, Park SJ, Lee JH, Song CS, Park HU. Predictive Factors for Severe Outcomes in Ischemic Colitis. Gut Liver 2016; 9:761-6. [PMID: 26347510 PMCID: PMC4625706 DOI: 10.5009/gnl15167] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background/Aims Ischemic colitis includes a wide clinical spectrum ranging from mild to severe forms. This study aimed to determine the factors that are related to the occurrence of severe ischemic colitis. Methods This multicenter study was conducted retrospectively in Korea. The patients were divided into mild and severe groups. This study surveyed clinical characteristics, blood tests, endoscopic findings, and imaging studies. Results In the comparison of comorbidities, the severe group had a higher ratio of chronic kidney disease than the mild group (p=0.001). In the blood test, the severe group had a reduced number of platelets (p=0.018) and a higher C-reactive protein value (p=0.001). The severe group had a higher ratio of involvement of the right colon (p=0.026). The Eastern Cooperative Oncology Group (ECOG) performance status score of the patients showed that the severe group had higher scores than the mild group (p=0.003). A multivariate analysis showed that chronic kidney disease and high ECOG performance status scores were significant risk factors. Conclusions If patients diagnosed with ischemic colitis are also treated for chronic kidney disease or have poor performance status, more attention and early intervention are necessary.
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Affiliation(s)
- Seok Reyol Choi
- Department of Internal Medicine, Busan Hangun Hospital, Busan, Korea
| | - Sam Ryong Jee
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Geun Am Song
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Seun Ja Park
- Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Korea
| | - Jong Hun Lee
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Chul Soo Song
- Department of Internal Medicine, Good Samsun Hospital, Busan, Korea
| | - Hee Ug Park
- Department of Internal Medicine, Maryknoll Medical Center, Busan, Korea
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Peixoto A, Silva M, Gaspar R, Morais R, Pereira P, Macedo G. Predictive factors of short-term mortality in ischaemic colitis and development of a new prognostic scoring model of in-hospital mortality. United European Gastroenterol J 2016; 5:432-439. [PMID: 28507756 DOI: 10.1177/2050640616658219] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 06/12/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Ischaemic colitis (IC) is the most common form of intestinal ischaemia with a wide spectrum of severity, with possible risk of death. OBJECTIVE The purpose of this study was to evaluate predictive factors of in-hospital and short-term mortality, in a cohort of patients with IC. METHODS Retrospective analysis of IC cases diagnosed between 2008-2013 in a single tertiary centre, with assessment of factors at the time of diagnosis associated with in-hospital and 90-day mortality. RESULTS Of the 203 patients included (132 women), 47 (23%) died during the follow-up (median: 16 months). There were 21 patients (45%) who died during hospitalization and at 90 days there were 30 deaths (64% of total). In multivariate analysis, need for vasopressor support (odds ratio (OR) 11.21; 95% confidence interval (CI): 2.31-54.24; p = 0.01), Intermediate or Intensive Care Unit (ICU): admission (OR 7.01; 95% CI: 1.48-33.16; p = 0.014) and atrial fibrillation (OR 4.99; 95% CI: 1.1-26.23; p = 0.048) were independently and significantly associated with in-hospital mortality. Using the coefficients of the estimated logistic model, we calculated a scoring model to predict the occurrence of in-hospital mortality. The presence of all three risk factors predicted a probability of death of 32% with an area under the receiver operating characteristic curve (AUROC) of 0.89 (95% CI 0.80-0.98. At 90 days, the presence of chronic kidney disease (OR 7.46; 95% CI: 1.87-29.73; p = 0.002), and male sex (OR 5.85; 95% CI: 1.57-21.83; p = 0.009) were also independently associated with mortality. CONCLUSIONS Most deaths in ischaemic colitis occur in the first 90 days after admission, sharing similar risk factors. Assessment of the presence of atrial fibrillation, need of vasopressor support or hospitalization in the intermediate/intensive care unit provides a useful tool to estimate in-hospital mortality and to establish the management for patients admitted for ischaemic colitis.
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Affiliation(s)
- Armando Peixoto
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Marco Silva
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rui Gaspar
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rui Morais
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Pereira
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
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Cotter TG, Bledsoe AC, Sweetser S. Colon Ischemia: An Update for Clinicians. Mayo Clin Proc 2016; 91:671-7. [PMID: 27150214 DOI: 10.1016/j.mayocp.2016.02.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/08/2016] [Accepted: 02/10/2016] [Indexed: 02/07/2023]
Abstract
Colon ischemia (CI) is an underrecognized entity associated with high morbidity and mortality. Establishing the diagnosis and initiating appropriate and timely treatment is critical for improving outcomes. Colon ischemia is a disease spectrum that requires a full understanding for recognition and treatment. This review outlines the full spectrum of CI management from initial presentation to medical and surgical treatment.
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Affiliation(s)
| | - Adam C Bledsoe
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Seth Sweetser
- Division of Gastroenterology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
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