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Original Article
Characteristics of Clinical Features between Isolated Left Side Ischemic Colitis and Non-Isolated Left Side Ischemic Colitis
Jae Joon Heo1, Hyung Hun Kim2, Jun Young Song1, Seun Ja Park1, Moo In Park1, Won Moon1
Kosin Medical Journal 2013;28(2):99-106.
DOI: https://doi.org/10.7180/kmj.2013.28.2.99
Published online: January 19, 2013

1Department of Internal Medicine, College of Medicine, Kosin University, Busan, Korea

2Department of Internal Medicine, College of Medicine, Catholic University, Seoul, Korea

Corresponding author: Hyung Hun Kim, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 137-701, Korea TEL: +82-2-2258-2038 FAX: +82-2-2258-2039 E-mail: drhhkim@gmail.com
• Received: March 7, 2013   • Accepted: June 26, 2013

Copyright © 2013 Kosin University School of Medicine Proceedings

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Objectives
    Compared with all other patterns, isolated right colon ischemia has been found to be more associated with coronary artery disease and a poor prognosis. However, there has been no research on comparing isolated left side ischemic colitis (ILIC) and non-ILIC with vascular assessment. The aim of the present study was to evaluate the clinical and laboratory findings between these two different forms of ischemic colitis (IC).
  • Methods
    We retrospectively investigated differences in clinical features, course, and mesenteric vascular (superior mesenteric artery, SMA; inferior mesenteric artery, IMA) findings between ILIC and non-ILIC patients who were hospitalized at Kosin University Gospel Hospital from 2004 to 2010.
  • Results
    Our study population comprised 221 patients, all of whom met our entry criteria of biopsy-proven or -compatible IC. Of the 221 patients, 46 (20.8%) had non-ILIC. Congestive heart failure and hypercholesterolemia were more frequently observed in the non-ILIC group (P = 0.003 and P = 0.020, respectively). SMA atherosclerosis and SMA stenosis were more frequently observed in the non-ILIC group (P = 0.006 and P = 0.001, respectively). Recovery periods were longer in the non-ILIC group (P = 0.039), and mortality was lower in the ILIC group (6.9% vs. 17.3%, P = 0.026).
  • Conclusions
    ILIC has favorable outcomes compared with non-ILIC. Furthermore, non-ILIC showed a close relationship with SMA atherosclerosis and SMA stenosis, which should be investigated carefully in the clinical field.
  • Keywords: Atherosclerosis; Ischemic colitis; Stenosis; Superior mesenteric artery
Fig. 1.
Severity of ischemic colitis assessed by colonoscopy. (A) Mild ischemic colitis is defined as segmental hyperemic erosive mucosal change without deep ulceration. (B) Moderate ischemic colitis is defined as hyperemic mucosal change and focal ulceration with severe edema. (C) Severe ischemic colitis is defined as extensive exfoliation of colonic mucosa combined with deep ulceration or gangrene.
kmj-28-99f1.jpg
Fig. 2.
Kaplan–Meier survival curve comparing ILIC with non-ILIC. Mortality is lower in the ILIC group than non-ILIC group (6.9% vs. 17.3%, P = 0.026, hazard ratio = 0.286, 95% confidence interval = 0.095-0.855). ILIC, isolated left side ischemic colitis.
kmj-28-99f2.jpg
Table 1.
Baseline characteristics of patients in two groups at symptomonset
Non-ILIC n = 46 ILIC n = 175 P-Value
Age, year, mean ± SD 66.5 ± 11.9 64.0 ± 12.4 0.656
Sex, male, n (%) 17 (36.9) 71 (40.6) 0.224
Recent operation, n (%) 0 (0.0) 9. (5.1) 0.210
ECOG performance status 0.124
Score 1, n (%) 2 (4.3) 20 (11.4)
Score 2, n (%) 11 (24.0) 36 (20.6)
Score 3, n (%) 23 (50.0) 62 (35.4)
Score 4, n (%) 10 (21.7) 58 (32.6)
Laboratory findings
Albuming, g/dL, mean ± SD 3.1 ± 0.7 3.9 ± 2.8 0.058
Total protein, g/dL, mean ± SD 5.8 ± 0.9 6.5 ± 0.8 < 0.001*
Total cholesterol, mg/dL, mean ± SD 143.2 ± 61.5 109.3 ± 63.0 0.001**
Triglyceride, mg/dL, mean ± SD 81.2 ± 60.9 78.7 ± 46.2 0.102
Hgb, g/dL, mean ± SD 12.2 ± 2.2 12.9 ± 2.1 0.216
WBC, counts/dL, mean ± SD 13,145.1 ± 6,702.2 11,828.3 ± 63,265 0.052
CRP, mg/dL, mean ± SD 7.7 ± 7.7 5.1 ± 7.1 0.049***
ESR, mg/dL, mean ± SD 22.3 ± 21.2 32.8 ± 37.0 0.066

ILIC, isolated left side ischemic colitis; Non-ILIC, non isolated left side ischemic colitis; ECOG, eastem cooperative oncology group; Hgb, hemoglobin; WBC, white blood cell; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate.

Table 2.
Medical comorbidities in the tow groups
Non-ILIC n = 46 ILIC n = 175 P-Value
Cardiovascular disease
Hypertension, n (%) 19 (41.3) 82 (46.9) 0.512
Ischemic heart disease, n (%) 7 (15.2) 24 (13.7) 0.794
Atrial fibrillation, n (%) 18 (39.1) 69 (39.4) 0.971
Congestive heart failure, n (%) 8 (17.4) 8 (4.6) 0.003*
Cerebrovascular accident, n (%) 10 (21.7) 23 (13.1) 0.164
Diabetes mellitus, n (%) 16 (34.8) 47 (26.9) 0.359
Peripheral vascular disease, n (%) 2 (4.3) 6 (3.4) 0.673
Autoimmune disease, n (%) 2 (4.3) 8 (4.6) 1.000
Hypercholesterolemia, n (%) 9 (19.5) 12 (6.9) 0.020**
Chronic renal insufficiency, n (%) 4 (8.7) 11 (6.3) 0.522
Chronic obstructive pulmonary disease, n (%) 7 (15.2) 15 (8.5) 0.180
Hyperthyroidism, n (%) 1 (2.2) 3 (1.7) 1.000
Hypothyroidism, n (%) 2 (4.3) 6 (3.4) 0.673

ILIC, isolated left side ischemic colitis; Non-ILIC, non isolated left side ischemic colitis.

*Odds ratio = 4.395, 95% confidence interval = 1.551-12.391.

**Odds ratio = 3.304, 95% confidence interval = 1.297-8.417.

Table 3.
Comparison of endoscopic findings and mesenteric vascular finding between two groups
Non-ILIC n = 46 ILIC n = 175 P-Value
Endoscopic findings 0.524
Severe 16 (34.8) 50 (28.6)
Moderate 24 (52.2) 91 (52.0)
Mild 6 (13.0) 34 (19.4)
Vascular findings†
SMA calcification, n (%) 23 (50.0) 86 (49.1) 0.918
SMA atherosclerosis, n (%) 6 (13.0) 4 (2.3) 0.006*
SMA stenosis, n (%) 6 (13.0) 2 (1.2) 0.001**
IMA atherosclerosis, n (%) 1 (2.1) 4 (2.3) 0.964
Mesenteric ischenmia, n (%) 10 (21.7) 4 (2.3) 0.497

ILIC, isolated left side ischemic colitis; Non-ILIC, non isolated left side ischemic colitis; SMA, superior mesenteric artery; IMA, inferior mesenteric artery.

†Vascular findings were accessed by dynamic computed tomography and angiography.

*Odds ratio = 6.412, 95% confidence interval = 1.728 to 23.793.

**Odds ratio = 12.975, 95% confidence interval = 2.525 to 66.677.

Table 4.
Clinical course between Non-ILIC and ILIC
Non-ILIC n = 46 ILIC n = 175 P-Value
Recovery period of ischemic colitis†, days, mean ± SD 9.5 ± 13.1 5.3 ± 8.5 0.039*
Hospitalization period, days, mean ± SD 24.8 ± 17.1 19.6 ± 16.6 0.061
Operation, n (%) 5 (10.8) 5 (2.9) 0.035**

ILIC, isolated left side ischemic colitis; Non-ILIC, non isolated left side ischemic colitis.

†Recovery period is the days between symptom onset and the resolution of ischemic colitis proved by colonoscopy.

*95% confidence interval = 0.210-8.272.

**Odds ratio = 4.146, 95% confidence interval = 1.146-14.997.

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        Characteristics of Clinical Features between Isolated Left Side Ischemic Colitis and Non-Isolated Left Side Ischemic Colitis
        Kosin Med J. 2013;28(2):99-106.   Published online January 19, 2013
        DOI: https://doi.org/10.7180/kmj.2013.28.2.99
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      Characteristics of Clinical Features between Isolated Left Side Ischemic Colitis and Non-Isolated Left Side Ischemic Colitis
      Image Image
      Fig. 1. Severity of ischemic colitis assessed by colonoscopy. (A) Mild ischemic colitis is defined as segmental hyperemic erosive mucosal change without deep ulceration. (B) Moderate ischemic colitis is defined as hyperemic mucosal change and focal ulceration with severe edema. (C) Severe ischemic colitis is defined as extensive exfoliation of colonic mucosa combined with deep ulceration or gangrene.
      Fig. 2. Kaplan–Meier survival curve comparing ILIC with non-ILIC. Mortality is lower in the ILIC group than non-ILIC group (6.9% vs. 17.3%, P = 0.026, hazard ratio = 0.286, 95% confidence interval = 0.095-0.855). ILIC, isolated left side ischemic colitis.

      Fig. 1.

      Fig. 2.

      Characteristics of Clinical Features between Isolated Left Side Ischemic Colitis and Non-Isolated Left Side Ischemic Colitis

      Baseline characteristics of patients in two groups at symptomonset

      Non-ILIC n = 46 ILIC n = 175 P-Value
      Age, year, mean ± SD 66.5 ± 11.9 64.0 ± 12.4 0.656
      Sex, male, n (%) 17 (36.9) 71 (40.6) 0.224
      Recent operation, n (%) 0 (0.0) 9. (5.1) 0.210
      ECOG performance status 0.124
      Score 1, n (%) 2 (4.3) 20 (11.4)
      Score 2, n (%) 11 (24.0) 36 (20.6)
      Score 3, n (%) 23 (50.0) 62 (35.4)
      Score 4, n (%) 10 (21.7) 58 (32.6)
      Laboratory findings
      Albuming, g/dL, mean ± SD 3.1 ± 0.7 3.9 ± 2.8 0.058
      Total protein, g/dL, mean ± SD 5.8 ± 0.9 6.5 ± 0.8 < 0.001*
      Total cholesterol, mg/dL, mean ± SD 143.2 ± 61.5 109.3 ± 63.0 0.001**
      Triglyceride, mg/dL, mean ± SD 81.2 ± 60.9 78.7 ± 46.2 0.102
      Hgb, g/dL, mean ± SD 12.2 ± 2.2 12.9 ± 2.1 0.216
      WBC, counts/dL, mean ± SD 13,145.1 ± 6,702.2 11,828.3 ± 63,265 0.052
      CRP, mg/dL, mean ± SD 7.7 ± 7.7 5.1 ± 7.1 0.049***
      ESR, mg/dL, mean ± SD 22.3 ± 21.2 32.8 ± 37.0 0.066

      Medical comorbidities in the tow groups

      Non-ILIC n = 46 ILIC n = 175 P-Value
      Cardiovascular disease
      Hypertension, n (%) 19 (41.3) 82 (46.9) 0.512
      Ischemic heart disease, n (%) 7 (15.2) 24 (13.7) 0.794
      Atrial fibrillation, n (%) 18 (39.1) 69 (39.4) 0.971
      Congestive heart failure, n (%) 8 (17.4) 8 (4.6) 0.003*
      Cerebrovascular accident, n (%) 10 (21.7) 23 (13.1) 0.164
      Diabetes mellitus, n (%) 16 (34.8) 47 (26.9) 0.359
      Peripheral vascular disease, n (%) 2 (4.3) 6 (3.4) 0.673
      Autoimmune disease, n (%) 2 (4.3) 8 (4.6) 1.000
      Hypercholesterolemia, n (%) 9 (19.5) 12 (6.9) 0.020**
      Chronic renal insufficiency, n (%) 4 (8.7) 11 (6.3) 0.522
      Chronic obstructive pulmonary disease, n (%) 7 (15.2) 15 (8.5) 0.180
      Hyperthyroidism, n (%) 1 (2.2) 3 (1.7) 1.000
      Hypothyroidism, n (%) 2 (4.3) 6 (3.4) 0.673

      Comparison of endoscopic findings and mesenteric vascular finding between two groups

      Non-ILIC n = 46 ILIC n = 175 P-Value
      Endoscopic findings 0.524
      Severe 16 (34.8) 50 (28.6)
      Moderate 24 (52.2) 91 (52.0)
      Mild 6 (13.0) 34 (19.4)
      Vascular findings†
      SMA calcification, n (%) 23 (50.0) 86 (49.1) 0.918
      SMA atherosclerosis, n (%) 6 (13.0) 4 (2.3) 0.006*
      SMA stenosis, n (%) 6 (13.0) 2 (1.2) 0.001**
      IMA atherosclerosis, n (%) 1 (2.1) 4 (2.3) 0.964
      Mesenteric ischenmia, n (%) 10 (21.7) 4 (2.3) 0.497

      Clinical course between Non-ILIC and ILIC

      Non-ILIC n = 46 ILIC n = 175 P-Value
      Recovery period of ischemic colitis†, days, mean ± SD 9.5 ± 13.1 5.3 ± 8.5 0.039*
      Hospitalization period, days, mean ± SD 24.8 ± 17.1 19.6 ± 16.6 0.061
      Operation, n (%) 5 (10.8) 5 (2.9) 0.035**
      Table 1. Baseline characteristics of patients in two groups at symptomonset

      ILIC, isolated left side ischemic colitis; Non-ILIC, non isolated left side ischemic colitis; ECOG, eastem cooperative oncology group; Hgb, hemoglobin; WBC, white blood cell; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate.

      Table 2. Medical comorbidities in the tow groups

      ILIC, isolated left side ischemic colitis; Non-ILIC, non isolated left side ischemic colitis.

      Odds ratio = 4.395, 95% confidence interval = 1.551-12.391.

      Odds ratio = 3.304, 95% confidence interval = 1.297-8.417.

      Table 3. Comparison of endoscopic findings and mesenteric vascular finding between two groups

      ILIC, isolated left side ischemic colitis; Non-ILIC, non isolated left side ischemic colitis; SMA, superior mesenteric artery; IMA, inferior mesenteric artery.

      Vascular findings were accessed by dynamic computed tomography and angiography.

      Odds ratio = 6.412, 95% confidence interval = 1.728 to 23.793.

      Odds ratio = 12.975, 95% confidence interval = 2.525 to 66.677.

      Table 4. Clinical course between Non-ILIC and ILIC

      ILIC, isolated left side ischemic colitis; Non-ILIC, non isolated left side ischemic colitis.

      Recovery period is the days between symptom onset and the resolution of ischemic colitis proved by colonoscopy.

      95% confidence interval = 0.210-8.272.

      Odds ratio = 4.146, 95% confidence interval = 1.146-14.997.

      Table 1.

      Table 2.

      Table 3.

      Table 4.

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