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Natural history of outpatient-onset ischemic colitis compared with other lower gastrointestinal bleeding: a long-term
Naoyoshi Nagata1, Ryota Niikura, Tomonori Aoki
1Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine (NCGM), 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan, nnagata_ncgm@yahoo.co.jp.
Insights
Outpatient ischemic colitis typically presents as left-sided colitis and often resolves with conservative treatment. Patients experience lower transfusion needs and rebleeding rates compared to other lower gastrointestinal bleeding (LGIB) cases.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Internal Medicine
Background:
- Ischemic colitis is a common cause of lower gastrointestinal bleeding (LGIB).
- The long-term clinical course of outpatient-onset ischemic colitis is not well-established.
- Understanding outcomes is crucial for patient management and resource allocation.
Purpose of the Study:
- To determine the in-hospital and long-term clinical outcomes of ischemic colitis.
- To compare these outcomes with those of other causes of LGIB.
- To analyze recurrence and mortality rates after discharge.
Main Methods:
- A cohort study of 370 outpatients hospitalized for ischemic colitis (n=57) or other LGIB (n=313).
- Colonoscopy was performed on all patients.
- In-hospital outcomes (transfusion, intervention, mortality, length of stay) and long-term outcomes (recurrence, mortality) were analyzed.
Main Results:
- Ischemic colitis was predominantly left-sided (88%).
- Ischemic colitis patients required fewer transfusions and interventions, and had shorter hospital stays compared to other LGIB.
- Long-term rebleeding rates were significantly lower in ischemic colitis (5.3%) versus other LGIB (19.4%).
Conclusions:
- Outpatient-onset ischemic colitis is usually left-sided and amenable to conservative management.
- Patients with ischemic colitis demonstrate favorable short-term outcomes with reduced transfusion and bleeding.
- Long-term follow-up reveals significantly lower recurrence rates for ischemic colitis compared to other LGIB.
Purposes:
The long-term clinical course of outpatient-onset ischemic colitis remains unknown. Our aims are to elucidate the in- and out-of-hospital clinical outcomes of ischemic colitis and compare them with those of lower gastrointestinal bleeding (LGIB).
Method:
A cohort of 370 outpatients was hospitalized for ischemic colitis (n = 57) or other LGIB (n = 313). All patients had undergone colonoscopy. During hospitalization, the need for transfusion or interventions, further bleeding, mortality, and length of hospital stay were measured. After discharge, long-term recurrence and mortality were analyzed by the Kaplan-Meier method.
Results:
Colonoscopy revealed that 88% of ischemic colitis cases were left sided. Compared with other LGIB, ischemic colitis cases had significantly lower transfusion requirements (p < 0.01), further bleeding (p = 0.02), endoscopic intervention (p < 0.01), and shorter hospital stay (p = 0.03). No significant differences between the groups were noted in the need for surgery, angiographic procedures, or mortality during hospitalization. During a mean follow-up of 22 months, rebleeding was significantly lower (log-rank test; p < 0.01) in ischemic colitis cases (5.3%) than in other LGIB cases (19.4%) after discharge. During the mean follow-up period of 29 months, 1 patient (1.8%) with ischemic colitis and 18 patients (5.8%) with other LGIB died (log-rank test; p = 0.41).
Conclusions:
Outpatient-onset ischemic colitis patients usually had left-sided colitis, recovered with conservative short-term treatment and had lower transfusion requirements and further bleeding compared with other LGIB patients. After discharge, patients with outpatient-onset ischemic colitis had lower recurrence over the long term than other LGIB patients.
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