Clinical patterns and outcomes of ischaemic colitis: results of the Working Group for the Study of Ischaemic Colitis in Spain (CIE study).

Este artículo es el resultado de un arduo trabajo del Dr. Miguel A. Montoro Huguet del Servicio de Gastroenterología del Hospital San Jorge de Huesca, dirigiendo al Grupo de Trabajo para el Estudio de la Colitis Isquémica en España (CIE study). El estudio ha permitido recoger casos de isquemia colónica (la forma más frecuente de isquemia intestinal) en 24 hospitales españoles, entre Septiembre de 2005 y Marzo de 2007. Es preciso reseñar la importante colaboración del Profesor Lawrence J. Brandt del Montefiore Medical Center de Nueva York.

La colaboración que desde el Servicio de Cirugía B del Hospital Clínico Universitario Lozano Blesa de Zaragoza hemos prestado, me permite incluirlo en este blog.

Scand J Gastroenterol. 2011 Feb;46(2):236-46.

Author names:
Montoro MA, Brandt LJ, Santolaria S, Gomollon F, Sánchez Puértolas B, Vera J, Bujanda L, Cosme A, Cabriada JL, Durán M, Mata L, Santamaría A, Ceña G, Blas JM, Ponce J, Ponce M, Rodrigo L, Ortiz J, Muñoz C, Arozena G, Ginard D, López-Serrano A, Castro M, Sans M, Campo R, Casalots A, Orive V, Loizate A, Titó L, Portabella E, Otazua P, Calvo M, Botella MT, Thomson C, Mundi JL, Quintero E, Nicolás D, Borda F, Martinez B, Gisbert JP, Chaparro M, Jimenez Bernadó A, Gómez-Camacho F, Cerezo A, Casal Nuñez E; Workgroup for the Study of Ischaemic Colitis of the Spanish Gastroenterological Association (GTECIE-AEG).
SourceDepartment of Gastroenterology, Hospital San Jorge, Huesca, Spain. montorohuguet@gmail.com

Abstract
Background. There is a lack of prospective studies evaluating the natural history of colonic ischaemia (CI). We performed such a study to evaluate the clinical presentation, outcome, and mortality as well as clinical variables associated with poor prognosis.
Methods. An open, prospective, and multicentre study was conducted in 24 Spanish hospitals serving a population of 3.5 million people. The study included only patients who met criteria for definitive or probable CI. A website (www.colitisisquemica.org) provided logistical support.
Results. A total of 364 patients met criteria for inclusion. CI was suspected clinically in only 24.2% of cases. The distribution of clinical patterns was as follows: reversible colopathy (26.1%), transient colitis (43.7%), gangrenous colitis (9.9%), fulminant pancolitis (2.5%), and chronic segmental colitis (17.9%). A total of 47 patients (12.9%) had an unfavorable outcome as defined by mortality and/or the need for surgery. Multivariate analysis identified the following signs as independent risk factors for an unfavorable outcome: abdominal pain without rectal bleeding [odds ratio (OR) 3.9; 95% confidence interval (CI) = 1.6–9.3], non-bloody diarrhoea (OR 10; 95% CI = 3.7–27.4), and peritoneal signs (OR 7.3; 95% CI = 2.7–19.6). Unfavorable outcomes also were more frequent in isolated right colon ischaemia (IRCI) compared with non-IRCI (40.9 vs. 10.3%, respectively; p < 0.0001). The overall mortality rate was 7.7%.
Conclusions. The clinical presentation of CI is very heterogeneous, perhaps explaining why clinical suspicion of this disease is so low. The presence of IRCI, and occurrence of peritoneal signs or onset of CI as severe abdominal pain without bleeding, should alert the physician to a potentially unfavorable course.

Keywords
Abdominal pain, bleeding, colorectal disease, diarrhoea, ischaemia

Puede accederse al texto completo del artículo a través del link
http://informahealthcare.com/doi/abs/10.3109/00365521.2010.525794