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Ischemic colitis in young adults: a single-institution experience
O A Preventza1, K Lazarides, M D Sawyer
1Department of Gastroenterologic and General Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, U.S.A.
Insights
Ischemic colitis is uncommon in young adults but presents with abdominal pain and bloody diarrhea. A female predominance was observed, with oral contraceptive use a potential factor, though etiology often remains unknown.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Internal Medicine
Background:
- Ischemic colitis is less understood in young adults compared to older populations.
- This study addresses the limited characterization of ischemic colitis in individuals under 50.
Purpose of the Study:
- To investigate the demographics, causes, clinical presentation, and outcomes of ischemic colitis in young adults.
- To identify risk factors and understand the disease course in this specific age group.
Main Methods:
- Retrospective analysis of 39 young adult patients (<50 years) diagnosed with ischemic colitis between 1990 and 1998.
- Data collected included patient demographics, potential etiologies, clinical symptoms, diagnostic methods (colonoscopy), and treatment outcomes.
Main Results:
- The mean age was 38 years, with a female predominance (1.8:1 ratio).
- Oral contraceptive use was noted in 52% of female patients.
- Common symptoms included abdominal pain (77%) and bloody diarrhea (54%).
- Nearly half (49%) had no identifiable predisposing factors.
- Most patients (77%) were managed non-surgically; 10 required surgery, with one death.
Conclusions:
- Ischemic colitis in young adults shows a female predominance, with oral contraceptive use as a potential association.
- Etiology is often unclear in this demographic.
- The condition has a low mortality rate in young adults, with most cases managed conservatively.
Abstract:
Ischemic colitis is not well characterized in the young adult population, despite its commonness in older patients. The aim of this study was to investigate the demographics, etiology, clinical features, and prognosis of ischemic colitis in young adults. We conducted a retrospective study of 39 young adults (<50 years of age) diagnosed with ischemic colitis over a period of 9 years (1990 to 1998). The mean age at diagnosis was 38 +/- 2 years (range 18 to 49 years); the female:male ratio was 1.8. Fifty-two percent (13 of 25) of women were using oral contraceptives at the time of diagnosis. Other potential associations identified were vascular thromboembolism (4 of 39), vasoactive drugs (4 of 39), hypovolemia (4 of 39), and vasculitis (2 of 39); 19 patients (49%) had no identifiable predisposing factors. Dominant presenting symptoms were abdominal pain (77%), bloody diarrhea (54%), and hematochezia (51%). Most patients were diagnosed at colonoscopy, and most disease was left sided. Twenty-nine patients were successfully managed with intravenous fluids, broad-spectrum antibiotics, and bowel rest; 10 patients required surgery. There was one disease-related death in the operative group. We found a strong female predominance and an association with oral contraceptive use, but almost half of the patients did not have an identifiable etiology. Mortality from ischemic colitis in this patient population is low.