Relationship Between Endoscopic Findings and Clinical Severity in Ischemic Colitis

Abstract

Background and Aim The incidence of ischemic colitis (IC) in Japan has been increasing due to the westernization of diet and the aging population. The aim of this study was to evaluate the relationship between endoscopic findings and clinical severity in IC. Methods This retrospective analysis included 106 cases diagnosed with IC that were divided into two groups based on endoscopic findings in the acute stage: redness and erosion (RE) versus longitudinal and circumferential ulcers (LCU). The clinical variables were compared between the two groups. In addition, we investigated the risk factors of IC associated with the severity of the endoscopic findings by multivariate logistic regression analysis. Results The percentage of cases presenting abdominal pain was significantly higher in the LCU group than that in the RE group (p=0.002), as were the baseline serum CRP levels (p=0.0001). The periods of hospitalization in LCU group were longer than in the RE group (p=0.0001). Multivariate logistic regression analysis indicated that ischemic heart disease (IHD) and connective tissue disease were the independent explanatory factor associated with the endoscopic severity of IC (p<0.05). Conclusion We showed clearly that the two endoscopic classifications were accurate indicators of severity and could be used to anticipate severity of IC. Furthermore, we confirmed that IHD and connective tissue disease were the exacerbating factor associated with the severity of endoscopic findings in IC.

Combination Treatment with Antibiotics and Glucocorticosteroids for Severe Ischemic Colitis

“…Several risk factors for severe IC and bad prognosis have been described [2,5]. Certain endoscopic findings have been related to severity of IC [11]. Even a validated prognostic scoring model has been developed [12].…”

“…Inclusion criteria for the final analysis were need of hospitalization, at least 1 day of predefined treatment, complete documentation of all clinical parameters including Charlson comorbidity index [10], total colonoscopy with severity index [11], positive histology, and laboratory tests (full blood count, C-reactive protein [CRP], lac-tate dehydrogenase [LDH], and total serum protein). Also stool testing for pathogens including Clostridium difficile was required.…”

“…Most patients showed a long segment (>10 cm) ischemic reaction. In total, 86.7% of the patients had longitudinal or circumferential ulcers which are endoscopically severe IC according to the classification by Beppu et al [11].…”

Ischemic colitis problems of diagnosis and treatment

“…Beppu and colaboratores showed that endoscopic classifications were accurate indicators of severity of ischemic colitis [19].…”

CT Findings in Acute, Subacute, and Chronic Ischemic Colitis: Suggestions for Diagnosis

“…Some authors consider colonoscopy as the test of choice for the diagnosis of IC; however, lower GI endoscopy is not without risk, especially in patients with severe colitis due to the risk of perforation [11, 13, 14]. For these reasons, imaging tests play an important role in the assessment and management of these patients, especially in acute phase (AP).…”