Asked by Kevin, Illinois
I have ischemic colitis. I was in the hospital for four days and got better. But a week later, the pain came back. Will I have this for the rest of my life?
Dr. Otis Brawley
Chief Medical Officer,
American Cancer Society
Ischemic colitis is an acute condition. In an attack, the large intestine or colon is not getting enough oxygenation due to decreased blood flow.
Symptoms of ischemic colitis are vague. They include: mild to severe abdominal pain and diarrhea, often bloody diarrhea.
The physician may consider many other illnesses before making the diagnosis. Ischemic colitis can have symptoms similar to infectious colitis, inflammatory bowel disease, diverticulitis, appendicitis and colon carcinoma.
Ischemic colitis is most commonly caused by a reduction in blood flow through a mesenteric artery. The superior and inferior mesenteric arteries supply oxygenated blood from the aorta to the small and large intestine respectively. The inferior mesenteric artery is most commonly affected.
The decrease in blood flow can be due to blockage or spasm of the mesenteric artery or decreased blood pressure. The decreased blood pressure is usually due to a heart problem or an over-reaction to a medication to lower blood pressure.
Ischemic colitis is rare. When it is found, it is usually in an elderly patient with a number of underlying illnesses. There are some cases described of long-distance runners developing it as their body shunts blood flow away from the bowel to muscle.
For the majority of patients (85%) the ischemic attack is transient, or temporary. Patients are treated with hydration and bowel rest, meaning nothing to eat or drink for several days. Ischemic colitis usually resolves without later problems.
A small portion of the 85% develop long-term complications after an attack. This can include prolonged inflammation of the bowel and a narrowing stricture of the bowel. These complications can seem like a prolonged attack of ischemic colitis. They may have to be treated with surgical removal of the affected part of the bowel.
While most have one time limited attack and it gets better, a few patients have repeated attacks. In this case, prognosis really depends on the cause of the ischemia. When there is a single occlusion of the artery, it might be treated with stent placement.
About 15% of patients with ischemic colitis have a severe complication. Most common are systemic infection (sepsis) and death of a part of the colon (bowel infarction). These patients often have gangrene of the bowel. These complications can make surgery difficult to perform and can be catastrophic and cause death in a matter of hours.
The American Gastroenterological Association (AGA) has issued guidelines on the diagnosis and management of intestinal ischemia.
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