What is ischemic colitis?
Ischemic colitis is a type of inflammation of the lining of the colon (colitis) caused by a reduction of flow in the blood vessels supplying the colon. The lining of the colon may appear reddened, sometimes with ulcerations.
What are the symptoms of ischemic colitis?
- Abdominal pain, which can be anywhere, but most often on the left side.
- Bloody stools, which usually occur after the pain begins
- Abdominal bloating, distension.
- Rarely, patients may not have any symptoms.
What causes ischemic colitis?
- Spontaneous, with no apparent underlying cause (this is common)
- Blood clot to the blood vessels supplying the colon (mesenteric vessels).
- Peripheral vascular disease
- A tendency for the blood to clot abnormally (hypercoaguable state).
- Low blood pressure from any cause (heart attack, congestive heart failure, etc.)
- Drugs (diuretics, estrogens, non-steroidal anti-inflammatories, simvastatin, cocaine, etc.)
- Long distance running
- Infection (CMV, E. coli O157:H7)
- Airplane flights
- Other causes
What are the complications of ischemic colitis?
- Usually the colitis will heal on its own (85% of cases). Most patients improve within one to two weeks.
- Persistent or recurrent colitis (failure of the inflammation to heal)
- Stricture (scar tissue which blocks the channel of the colon).
- Severe involvement may require hospitalization for more intensive treatment. Occasionally surgery may be required, but this is unusual.
What is the treatment for ischemic colitis?
- This depends on the severity; generally, the inflammation will heal on its own.
- You may be asked to stay on a bland, low-fiber diet for 1-2 weeks.
- Avoiding non-steroidal inflammatory drugs (ibuprofen, etc) may speed the healing of the colitis.
- Cessation of smoking improves the health of the blood vessels supplying your colon.
- If a drug is identified that may have caused your ischemic colitis, you may be asked to stop it.
- If you have had blood clots in other areas of the body, or a family history of blood clots, then you may be asked to undergo testing for a blood-clotting disorder (hypercoaguable state).
- Rarely, you may have to undergo additional testing, which may include an evaluation of the blood vessels supplying your small bowel and colon. This could either be in the form of an imaging study (either MRI of the blood vessels, or angiography).
- You may require a repeat colonoscopy to demonstrate that the colon has healed; this depends on the severity of the involvement, and will be determined by your physician.