Risk factors associated with recurrent ischemic colitis ‒ A 10-year retrospective study

Recurrent ischemic colitis (IC) is uncommon but clinically relevant, and its risk factors remain poorly defined. We aimed to assess the prevalence of recurrence and identify associated clinical predictors.

We conducted a retrospective single-center cohort study including all patients diagnosed with IC at a regional hospital, between January 2011 and December 2021. Cases were identified using ICD-9/ICD-10 codes and confirmed by clinical presentation and at least one diagnostic modality (computed tomography, colonoscopy, or histology). Patients younger than 18 years, pregnant women, and those with mechanical or inflammatory causes of colitis were excluded. Recurrent IC was defined as a new episode after a ≥30-day symptom-free interval. Demographic, clinical, imaging, and outcome data were collected. Associations with recurrence were analyzed using odds ratios (OR) with 95% confidence intervals (CI).

Of 142 patients, 11 (7.7%) had recurrent IC. Recurrence was associated with smoking (OR 5.6, 95% CI 1.5-20.3), coronary artery disease (OR 4.1, 95% CI 1.1-15.6), prior laparotomy (OR 5.8, 95% CI 1.3-26.0), and clopidogrel use (OR 5.2, 95% CI 1.3-20.1). Patients with recurrence required blood transfusion more often (OR 7.8, 95% CI 1.9-31.5) but presented with hematochezia less frequently (OR 0.16, 95% CI 0.04-0.57). Imaging and endoscopic findings were comparable across groups, although colonic necrosis was absent in recurrent cases.

Recurrent IC occurred in 7.7% of patients and was linked to smoking, cardiovascular disease, prior laparotomy, and clopidogrel therapy. Its presentation was often less typical, which may hinder early recognition. Prospective, multicenter studies are required to confirm these findings.