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Journal of Digestive Diseases 2014; 15; 606–613
doi: 10.1111/1751-2980.12182
Original article
Ischemic colitis: A forgotten entity. Results of a retrospective study in 118 patients Muhammed SHERID,* Humberto SIFUENTES,† Salih SAMO,‡ Samian SULAIMAN,‡ Husein HUSEIN,§ Ruth TUPPER,‡ Sankara N SETHURAMAN,¶ Charles SPURR,† John A VAINDER‡ and Subbaramiah SRIDHAR† *Department of Internal Medicine, Division of Gastroenterology, CGH Medical Center, Sterling, ‡Department of Internal Medicine, Division of Gastroenterology, Saint Francis Hospital, Evanston, Illinois, †Section of Gastroenterology and Hepatology, ¶Department of Mathematics and Computer Science, Georgia Regents University, Augusta, Georgia, USA, and §Department of Internal Medicine, Division of Gastroenterology, University of Tishreen, Latakia, Syria
OBJECTIVE: The aim of our study was to document our 6-year experiences in identifing the clinical characteristics, laboratory findings, risk factors and the outcomes of patients with ischemic colitis (IC) in a community hospital setting. METHODS: The medical records of patients who were diagnosed with IC from 2007 to 2013 in two community hospitals were retrospectively reviewed. Their clinical characteristics, laboratory results, radiological, endoscopic and histological evidence, anatomic location of the lesion, comorbidities, concomitant use of drugs, and so on, were collected. RESULTS: A total of 118 patients with IC was identified, most were elderly individuals with a female predominance. The most common symptoms were abdominal pain, rectal bleeding and diarrhea. Hypertension, hyperlipidemia, coronary artery disease and KEY WORDS:
CONCLUSIONS: IC is majorly occurred in elderly with a female predominance. Cardiovascular disease and its assoicated risk factors are the most common comorbidities. Left colon is the most affected location of the disease and the overall mortality rate was 4.2%. Physicians should make every effort to identify these patients, especially those with high risks.
colitis, colonoscopy, computed tomography, histology, ischemic colitis.
Correspondence to: Subbaramiah SRIDHAR, Section of Gastroenterology and Hepatology, Georgia Regents University, 1120 15th Street BBR2538, Augusta, GA 30912, USA. Email: [email protected] Conflict of interest: None. The data were presented as a poster at the ACG Annual Scientific Meeting, San Diego, CA, USA, 11–16 October 2013. © 2014 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd
606
diabetes mellitus were the most common comorbidities. Erythema, edema and erosions/ ulcerations were the most common endoscopic findings. Left colon was the most affected location of lesion (84.8%), and there was one case of pancolitis. The descending colon was the most common affected segment, while rectum was the least affected segment. Severe IC occurred in 12.7% of the patients. Death within 30 days from the diagnosis of the disease occurred in 4.2%.
INTRODUCTION A sudden reduction of splanchnic blood flow to the colon results in an ischemic insult and may subsequently lead to ischemic colitis. Ischemic colitis is usually a segmental disease with a clear demarcation between the normal mucosa and the affected areas.1,2 Although the splenic flexure and rectosigmoid junction of the colon, also known as the watershed areas, are the most commonly affected areas, any segment of
Journal of Digestive Diseases 2014; 15; 606–613 the colon can be involved.3–5 There are critical points of blood supply in the anastomotic areas between the superior and inferior mesenteric artery as well as between the inferior mesenteric and internal iliac artery.1–7 In up to 50% of the populations the marginal vessels are poorly developed in the ascending colon, making it susceptible to ischemia.1 The predisposing factors for ischemic colitis are generally divided into two categories: vascular factors and bowel factors. Among the vascular factors, the most common pathophysiology for the development of ischemic colitis is the transient hypoperfusion to the colon.8–11 In general, systemic hypotension of any cause such as sepsis, hypovolemia, cardiogenic shock and third space shifting, and so on, would lead to colonic hypoperfusion, thus resulted in ischemic colitis. Moreover, vascular surgery, including abdominal aortic aneurysm repair, coronary artery bypass grafting, aortoiliac reconstruction surgery, endovascular repair of aortoiliac aneurysm and any surgery that requires aortic vascular clamping have been found to be associated with a high incidence of ischemic colitis.1,2,12–14 Vasospasm of the colonic vessels is another mechanism for the development of ischemic colitis, either due to systemic hypoperfusion, which shunts the blood from the intestine to the brain and other viable organs, or due to the exposure to vasoconstrictor drugs and substances that have direct or indirect effects on the splanchnic circulation, such as phenylephrine and cocaine.8,11 A third pathophysiological mechanism is thromboembolism due to either hypercoagulable states, including gene mutations and coagulation factor deficiencies, or cardiac emboli.11,15–17 According to the previous studies, 28–72% of the patients with ischemic colitis have one or more coagulation disorders.16,17 Vasculitis is another vascular mechanism for the development of ischemic colitis, as ischemia occurs more frequently in cases with systemic lupus erythematous (SLE) and antiphospholipid syndrome (APS).2,18,19 The bowel factors including constipation, irritable bowel syndrome (IBS), fecal impaction, colonic obstruction or any other conditions that potentially increase the intraluminal pressure might also cause ischemic colitis by compromising the blood flow to the colonic wall and lead to ischemic injury.2,11,14,19–21 With the widespread utility of colonoscopy and computed tomography (CT), population aging and the awareness of the disease, ischemic colitis has been increasingly diagnosed in the recent decades and has became one of the most common causes of acute
Our experience in ischemic colitis
607
lower gastrointestinal bleeding, accounting for 8.7– 23.7% of such cases.20,22–24 The aim of our study was to document our 6-year experiences in ischemic colitis and to further identify the clinical characteristics, diagnostic findings, risk factors and outcomes of patients with ischemic colitis in a community hospital setting. PATIENTS AND METHODS Medical records of the patients who were diagnosed as ischemic colitis from January 2007 to January 2013 in two community hospitals, CGH Medical Center in Sterling and Saint Francis Hospital (both in IL, USA) were retrospectively reviewed. Corresponding data including patients’ characteristics such as age and gender, etc., clinical symptoms and signs, laboratory examination results, radiological findings, endoscopic and histological features, the anatomic location of the lesion, comorbidities, concomitant utility of medications, disease progression either at home or in hospital, surgical intervention, blood transfusion, length of hospital stay, the requirement for intensive care unit (ICU) stay and mechanical ventilation, disease recurrence and all-cause mortality within 30 days from the diagnosis of the disease were collected from the medical records. Ischemic colitis was identified based on the International Classification of Diseases 9th version (ICD-9) codes (code 557.0: acute vascular insufficiency, and code 557.9: unspecific vascular insufficiency), because no specific codes have been allotted to ischemic colitis. All cases were carefully audited individually by chart review to confirm the diagnosis of ischemic colitis. The diagnosis of ischemic colitis was made based on patient’s symptoms and signs and negative stool studies for infections, with at least one diagnostic examination that was consistent with ischemic colitis based on CT scan, colonoscopy and/or histopathological evidence. Exclusion criteria were: (i) age less than 18 years; (ii) pregnancy and lactation; (iii) positive results for enteric pathogens including bacteria, virus and parasites, etc.; and (iv) colonic ischemia due to trauma or mechanical causes such as bowel obstruction, volvulus and hernia, acute or chronic mesenteric ischemia, acute flare of inflammatory bowel disease, and radiological or colonoscopic evidence of diverticulitis. In addition, any cases with equivocal or uncertain diagnosis of ischemic colitis or where ischemic colitis was merely considered in the differential diagnosis but never confirmed by objective modalities were also excluded. The study was approved by the Institutional Review Board of both
© 2014 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd
608
M Sherid et al.
institutions and was in collaboration with Georgia Regents University (Augusta, GA, USA).
Journal of Digestive Diseases 2014; 15; 606–613
Statistical analyses were performed using SAS 9.3 (SAS Institute, Cary, NC, USA). Data of all patients was entered into Microsoft Excel spreadsheet in a coded format, which was locked with a password. Quantitative variables were expressed as mean ± standard deviation, and enumeration data were expressed as numbers and percentages. Frequency distribution indicators were calculated by descriptive analysis. P ≤ 0.05 was regarded as statistically significant.
transfusion, ICU stay, mechanical ventilation and surgery were 20.3%, 19.5%, 11.9% and 11.9%, respectively. Five (4.2%) patients died within 30 days from the diagnosis of ischemic colitis due to ischemic colitis (n = 2), sepsis (n = 2) and sudden cardiac issue (n = 1); among them, 4 received surgery before their death, whereas the remaining one did not, and the interval from admission to death ranged from 3 to 29 days. Severe ischemic colitis, which was defined as ischemic colitis that required surgery or led to death within 30 days of diagnosis, occurred in 15 (12.7%) of the patients. The identifiable direct predisposing factors for ischemic colitis were constipation (13.6%), hypotension (5.9%) and use of certain drugs and vasculitis – as one group – (5.1%).
RESULTS
Diagnostic studies in patients with ischemic colitis
Characteristics of the patients with ischemic colitis
The patients’ peripheral blood white blood cell (WBC) count, hemoglobin (Hb), albumin, bicarbonate, sodium, creatinine, alanine aminotransferase (ALT), amylase, lipase, blood glucose and lactic acid in admission were 13.0 ± 6.2 × 109/L, 130.4 ± 18.9 g/L, 36.3 ± 5.3 g/L, 25.3 ± 3.7 mmol/L, 137.2 ± 13.8 mmol/L, 123.8 ± 79.6 μmol/L, 29.9 ± 16.8 U/L, 104.7 ± 173.1 U/L, 119.0 ± 116.7 U/L, 7.56 ± 3.95 mmol/L, and 0.5 ± 1.3 mmol/L, respectively (Table 2). Radiological findings were available in 90 (76.3%) of all the 118 patients, among them abdominal plain CT was performed in 31, CT with contrast in 54 and CT angiogram in 34. Of note, some patients had more than one CT scans. Bowel wall thickening, pericolonic fat stranding and induration were the most common radiological findings (72.2%, 60.0% and 22.2%, respectively). Colonoscopy was performed in 89 (75.4%) patients, with erythema, edema and erosions or ulcerations being the most three common findings (64.0%, 58.4% and 52.8%, respectively). Histopathology (either from endoscopic biopsy or surgical specimens) was available in 94 (79.7%), in which acute inflammation (72.3%), necrosis or exudate (41.5%) and chronic inflammation (35.1%) were the most common findings. The anatomic location of the involved colonic segments was based on surgical reports, CT and colonoscopy findings. If surgery was performed, surgical findings were taken for the involved location regardless of colonoscopic and radiological findings. If surgery was not performed and there was any discrepancy between CT and colonoscopy findings. Colonoscopy results were taken. The location of the lesion was divided into the right and left colon as well as specific segments (rectum, rectosigmoid junction, sigmoid, descending
Statistical analysis
During the study period, a total of 118 patients with ischemic colitis with a mean age of 69.4 ± 15.1 years and a female predominance (83.1%) were identified in both hospitals. The characteristics of the 118 patients are shown in Table 1. Most patients were Caucasians (82.2%), and a majority of the patients (87.3%) were elder than 50 years. In all patients with ischemic colitis, the most common symptoms were abdominal pain (82.2%), followed by rectal bleeding (74.6%) and diarrhea (55.1%). Nausea, vomiting, fever, abdominal distension and peritoneal signs were less frequently seen. The median interval from the onset of symptoms and signs to seeking medical assistance was 17.0 h. The most common comorbidities associated with ischemic colitis were hypertension (HTN; 79.5%), hyperlipidemia (HLD; 58.1%), coronary artery disease (CAD; 31.6%), diabetes mellitus (DM; 21.4%) and atrial fibrillation (AF; 17.9%), respectively. A history of any abdominal surgery was present in 56.9%, hysterectomy in 31.0%, cholecystectomy in 25.0% and appendectomy in 19.0%. The most commonly used concomitant medications were β-blockers (48.3%), angiotensin converting enzyme inhibitors (ACEI; 46.6%), statins (45.7%), aspirin (45.7%) and calcium channel blockers (CCB; 33.6%), respectively. We used the website: www.timeanddate.com to calculate the length of hospital stay and included both admission and discharge days in the calculations. The patients’ mean length of hospital stay was 6.7 ± 7.6 days. The proportions of patients in need of blood
© 2014 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd
Journal of Digestive Diseases 2014; 15; 606–613 Table 1.
Our experience in ischemic colitis
609
Clinical characteristics of all the patients with ischemic colitis
Clinical characteristics Mean age, years (mean ± SD) Gender, n (%) Female Male Age, n (%)
Journal of Digestive Diseases 2014; 15; 606–613
doi: 10.1111/1751-2980.12182
Original article
Ischemic colitis: A forgotten entity. Results of a retrospective study in 118 patients Muhammed SHERID,* Humberto SIFUENTES,† Salih SAMO,‡ Samian SULAIMAN,‡ Husein HUSEIN,§ Ruth TUPPER,‡ Sankara N SETHURAMAN,¶ Charles SPURR,† John A VAINDER‡ and Subbaramiah SRIDHAR† *Department of Internal Medicine, Division of Gastroenterology, CGH Medical Center, Sterling, ‡Department of Internal Medicine, Division of Gastroenterology, Saint Francis Hospital, Evanston, Illinois, †Section of Gastroenterology and Hepatology, ¶Department of Mathematics and Computer Science, Georgia Regents University, Augusta, Georgia, USA, and §Department of Internal Medicine, Division of Gastroenterology, University of Tishreen, Latakia, Syria
OBJECTIVE: The aim of our study was to document our 6-year experiences in identifing the clinical characteristics, laboratory findings, risk factors and the outcomes of patients with ischemic colitis (IC) in a community hospital setting. METHODS: The medical records of patients who were diagnosed with IC from 2007 to 2013 in two community hospitals were retrospectively reviewed. Their clinical characteristics, laboratory results, radiological, endoscopic and histological evidence, anatomic location of the lesion, comorbidities, concomitant use of drugs, and so on, were collected. RESULTS: A total of 118 patients with IC was identified, most were elderly individuals with a female predominance. The most common symptoms were abdominal pain, rectal bleeding and diarrhea. Hypertension, hyperlipidemia, coronary artery disease and KEY WORDS:
CONCLUSIONS: IC is majorly occurred in elderly with a female predominance. Cardiovascular disease and its assoicated risk factors are the most common comorbidities. Left colon is the most affected location of the disease and the overall mortality rate was 4.2%. Physicians should make every effort to identify these patients, especially those with high risks.
colitis, colonoscopy, computed tomography, histology, ischemic colitis.
Correspondence to: Subbaramiah SRIDHAR, Section of Gastroenterology and Hepatology, Georgia Regents University, 1120 15th Street BBR2538, Augusta, GA 30912, USA. Email: [email protected] Conflict of interest: None. The data were presented as a poster at the ACG Annual Scientific Meeting, San Diego, CA, USA, 11–16 October 2013. © 2014 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd
606
diabetes mellitus were the most common comorbidities. Erythema, edema and erosions/ ulcerations were the most common endoscopic findings. Left colon was the most affected location of lesion (84.8%), and there was one case of pancolitis. The descending colon was the most common affected segment, while rectum was the least affected segment. Severe IC occurred in 12.7% of the patients. Death within 30 days from the diagnosis of the disease occurred in 4.2%.
INTRODUCTION A sudden reduction of splanchnic blood flow to the colon results in an ischemic insult and may subsequently lead to ischemic colitis. Ischemic colitis is usually a segmental disease with a clear demarcation between the normal mucosa and the affected areas.1,2 Although the splenic flexure and rectosigmoid junction of the colon, also known as the watershed areas, are the most commonly affected areas, any segment of
Journal of Digestive Diseases 2014; 15; 606–613 the colon can be involved.3–5 There are critical points of blood supply in the anastomotic areas between the superior and inferior mesenteric artery as well as between the inferior mesenteric and internal iliac artery.1–7 In up to 50% of the populations the marginal vessels are poorly developed in the ascending colon, making it susceptible to ischemia.1 The predisposing factors for ischemic colitis are generally divided into two categories: vascular factors and bowel factors. Among the vascular factors, the most common pathophysiology for the development of ischemic colitis is the transient hypoperfusion to the colon.8–11 In general, systemic hypotension of any cause such as sepsis, hypovolemia, cardiogenic shock and third space shifting, and so on, would lead to colonic hypoperfusion, thus resulted in ischemic colitis. Moreover, vascular surgery, including abdominal aortic aneurysm repair, coronary artery bypass grafting, aortoiliac reconstruction surgery, endovascular repair of aortoiliac aneurysm and any surgery that requires aortic vascular clamping have been found to be associated with a high incidence of ischemic colitis.1,2,12–14 Vasospasm of the colonic vessels is another mechanism for the development of ischemic colitis, either due to systemic hypoperfusion, which shunts the blood from the intestine to the brain and other viable organs, or due to the exposure to vasoconstrictor drugs and substances that have direct or indirect effects on the splanchnic circulation, such as phenylephrine and cocaine.8,11 A third pathophysiological mechanism is thromboembolism due to either hypercoagulable states, including gene mutations and coagulation factor deficiencies, or cardiac emboli.11,15–17 According to the previous studies, 28–72% of the patients with ischemic colitis have one or more coagulation disorders.16,17 Vasculitis is another vascular mechanism for the development of ischemic colitis, as ischemia occurs more frequently in cases with systemic lupus erythematous (SLE) and antiphospholipid syndrome (APS).2,18,19 The bowel factors including constipation, irritable bowel syndrome (IBS), fecal impaction, colonic obstruction or any other conditions that potentially increase the intraluminal pressure might also cause ischemic colitis by compromising the blood flow to the colonic wall and lead to ischemic injury.2,11,14,19–21 With the widespread utility of colonoscopy and computed tomography (CT), population aging and the awareness of the disease, ischemic colitis has been increasingly diagnosed in the recent decades and has became one of the most common causes of acute
Our experience in ischemic colitis
607
lower gastrointestinal bleeding, accounting for 8.7– 23.7% of such cases.20,22–24 The aim of our study was to document our 6-year experiences in ischemic colitis and to further identify the clinical characteristics, diagnostic findings, risk factors and outcomes of patients with ischemic colitis in a community hospital setting. PATIENTS AND METHODS Medical records of the patients who were diagnosed as ischemic colitis from January 2007 to January 2013 in two community hospitals, CGH Medical Center in Sterling and Saint Francis Hospital (both in IL, USA) were retrospectively reviewed. Corresponding data including patients’ characteristics such as age and gender, etc., clinical symptoms and signs, laboratory examination results, radiological findings, endoscopic and histological features, the anatomic location of the lesion, comorbidities, concomitant utility of medications, disease progression either at home or in hospital, surgical intervention, blood transfusion, length of hospital stay, the requirement for intensive care unit (ICU) stay and mechanical ventilation, disease recurrence and all-cause mortality within 30 days from the diagnosis of the disease were collected from the medical records. Ischemic colitis was identified based on the International Classification of Diseases 9th version (ICD-9) codes (code 557.0: acute vascular insufficiency, and code 557.9: unspecific vascular insufficiency), because no specific codes have been allotted to ischemic colitis. All cases were carefully audited individually by chart review to confirm the diagnosis of ischemic colitis. The diagnosis of ischemic colitis was made based on patient’s symptoms and signs and negative stool studies for infections, with at least one diagnostic examination that was consistent with ischemic colitis based on CT scan, colonoscopy and/or histopathological evidence. Exclusion criteria were: (i) age less than 18 years; (ii) pregnancy and lactation; (iii) positive results for enteric pathogens including bacteria, virus and parasites, etc.; and (iv) colonic ischemia due to trauma or mechanical causes such as bowel obstruction, volvulus and hernia, acute or chronic mesenteric ischemia, acute flare of inflammatory bowel disease, and radiological or colonoscopic evidence of diverticulitis. In addition, any cases with equivocal or uncertain diagnosis of ischemic colitis or where ischemic colitis was merely considered in the differential diagnosis but never confirmed by objective modalities were also excluded. The study was approved by the Institutional Review Board of both
© 2014 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd
608
M Sherid et al.
institutions and was in collaboration with Georgia Regents University (Augusta, GA, USA).
Journal of Digestive Diseases 2014; 15; 606–613
Statistical analyses were performed using SAS 9.3 (SAS Institute, Cary, NC, USA). Data of all patients was entered into Microsoft Excel spreadsheet in a coded format, which was locked with a password. Quantitative variables were expressed as mean ± standard deviation, and enumeration data were expressed as numbers and percentages. Frequency distribution indicators were calculated by descriptive analysis. P ≤ 0.05 was regarded as statistically significant.
transfusion, ICU stay, mechanical ventilation and surgery were 20.3%, 19.5%, 11.9% and 11.9%, respectively. Five (4.2%) patients died within 30 days from the diagnosis of ischemic colitis due to ischemic colitis (n = 2), sepsis (n = 2) and sudden cardiac issue (n = 1); among them, 4 received surgery before their death, whereas the remaining one did not, and the interval from admission to death ranged from 3 to 29 days. Severe ischemic colitis, which was defined as ischemic colitis that required surgery or led to death within 30 days of diagnosis, occurred in 15 (12.7%) of the patients. The identifiable direct predisposing factors for ischemic colitis were constipation (13.6%), hypotension (5.9%) and use of certain drugs and vasculitis – as one group – (5.1%).
RESULTS
Diagnostic studies in patients with ischemic colitis
Characteristics of the patients with ischemic colitis
The patients’ peripheral blood white blood cell (WBC) count, hemoglobin (Hb), albumin, bicarbonate, sodium, creatinine, alanine aminotransferase (ALT), amylase, lipase, blood glucose and lactic acid in admission were 13.0 ± 6.2 × 109/L, 130.4 ± 18.9 g/L, 36.3 ± 5.3 g/L, 25.3 ± 3.7 mmol/L, 137.2 ± 13.8 mmol/L, 123.8 ± 79.6 μmol/L, 29.9 ± 16.8 U/L, 104.7 ± 173.1 U/L, 119.0 ± 116.7 U/L, 7.56 ± 3.95 mmol/L, and 0.5 ± 1.3 mmol/L, respectively (Table 2). Radiological findings were available in 90 (76.3%) of all the 118 patients, among them abdominal plain CT was performed in 31, CT with contrast in 54 and CT angiogram in 34. Of note, some patients had more than one CT scans. Bowel wall thickening, pericolonic fat stranding and induration were the most common radiological findings (72.2%, 60.0% and 22.2%, respectively). Colonoscopy was performed in 89 (75.4%) patients, with erythema, edema and erosions or ulcerations being the most three common findings (64.0%, 58.4% and 52.8%, respectively). Histopathology (either from endoscopic biopsy or surgical specimens) was available in 94 (79.7%), in which acute inflammation (72.3%), necrosis or exudate (41.5%) and chronic inflammation (35.1%) were the most common findings. The anatomic location of the involved colonic segments was based on surgical reports, CT and colonoscopy findings. If surgery was performed, surgical findings were taken for the involved location regardless of colonoscopic and radiological findings. If surgery was not performed and there was any discrepancy between CT and colonoscopy findings. Colonoscopy results were taken. The location of the lesion was divided into the right and left colon as well as specific segments (rectum, rectosigmoid junction, sigmoid, descending
Statistical analysis
During the study period, a total of 118 patients with ischemic colitis with a mean age of 69.4 ± 15.1 years and a female predominance (83.1%) were identified in both hospitals. The characteristics of the 118 patients are shown in Table 1. Most patients were Caucasians (82.2%), and a majority of the patients (87.3%) were elder than 50 years. In all patients with ischemic colitis, the most common symptoms were abdominal pain (82.2%), followed by rectal bleeding (74.6%) and diarrhea (55.1%). Nausea, vomiting, fever, abdominal distension and peritoneal signs were less frequently seen. The median interval from the onset of symptoms and signs to seeking medical assistance was 17.0 h. The most common comorbidities associated with ischemic colitis were hypertension (HTN; 79.5%), hyperlipidemia (HLD; 58.1%), coronary artery disease (CAD; 31.6%), diabetes mellitus (DM; 21.4%) and atrial fibrillation (AF; 17.9%), respectively. A history of any abdominal surgery was present in 56.9%, hysterectomy in 31.0%, cholecystectomy in 25.0% and appendectomy in 19.0%. The most commonly used concomitant medications were β-blockers (48.3%), angiotensin converting enzyme inhibitors (ACEI; 46.6%), statins (45.7%), aspirin (45.7%) and calcium channel blockers (CCB; 33.6%), respectively. We used the website: www.timeanddate.com to calculate the length of hospital stay and included both admission and discharge days in the calculations. The patients’ mean length of hospital stay was 6.7 ± 7.6 days. The proportions of patients in need of blood
© 2014 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd
Journal of Digestive Diseases 2014; 15; 606–613 Table 1.
Our experience in ischemic colitis
609
Clinical characteristics of all the patients with ischemic colitis
Clinical characteristics Mean age, years (mean ± SD) Gender, n (%) Female Male Age, n (%)
