Quantifying risk factors for ischemic colitis: A nationwide, retrospective cohort study
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ORIGINAL ARTICLE
Quantifying risk factors for ischemic colitis: A nationwide, retrospective cohort study Patrick A. Twohig 1
&
Aakash Desai 1 & Jacob Skeans 2 & Nisheet Waghray 3
Received: 22 February 2020 / Accepted: 5 May 2020 # Indian Society of Gastroenterology 2020
Abstract Background Despite identifying numerous factors associated with colonic ischemia, the relative risk has been variable and not thoroughly evaluated. Hence, we aimed to quantify the risk of diseases and medications associated with ischemic colitis (IC). Methods A population-based retrospective analysis in International Business Machines (IBM) Explorys (1999–2018), a pooled, de-identified database of 57 million patients in the USA, was performed. Odds ratios (OR) were calculated between IC and other diseases/medications. IC patients were also stratified by age to assess trends of IC in different age groups. Results A total of 1560 patients had IC in the database. Hyperlipidemia had the highest association with IC (OR 15.3), consistent with prior reports of atherosclerosis being a major risk factor for IC. Hypertension, congestive heart failure, constipation, prior abdominal surgery, and atrial fibrillation all conferred odds greater than 10, which is consistent with prior reports. Novel findings of our study include that beta blockers (OR 9.6) and pro-inflammatory disease states such as vasculitis, rheumatoid arthritis, and malignancy all increase the risk of IC. Conclusion Early identification of IC is critical for minimizing morbidity and mortality. Epidemiologic information could be integrated with current clinical algorithms to more rapidly identify patients at risk.
Keywords Abdominal pain . Bowel ischemia . Epidemiology . Gastrointestinal bleeding . Hyperlipidemia . Ischemic colitis . Large intestine . Mesenteric vessel . Risk factors
* Patrick A. Twohig [email protected] 1
Department of Internal Medicine, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
2
Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH 43210, USA
3
Department of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
Indian J Gastroenterol
Bullet points of the study highlights What is already known? Twenty percent of patients hospitalized with lower gastrointestinal (GI) bleeding have ischemic colitis (IC). Numerous risk factors have been associated with IC, but the relative risk of these different factors has not been well-documented. What is new in this study? Hyperlipidemia, hypertension, congestive heart failure, constipation, prior abdominal surgery, and atrial fibrillation all conferred an odds ratio >10 for IC. Beta blockers, opioids, and non-steroidal anti-inflammatory drugs (NSAIDs) were medications most associated with IC. What are the future clinical and research implications of the study findings? Quantifying ri
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