Ischemic colitis

Overview

Ischemic colitis is a condition in which the colon becomes inflamed due to reduced blood flow, or ischemia, to the affected area. When tissues are deprived of oxygen, they can become damaged, which prompts the body’s response of inflammation. This inflammation can lead to discomfort, swelling, and bleeding, but it is a natural part of the healing process. Ischemic colitis primarily affects the mucosa, or inner lining, of one section of the colon. However, in cases of more severe or prolonged ischemia, the damage may extend deeper into the colon.
Misdiagnosis can occur with ischemic colitis since its symptoms can resemble those of other gastrointestinal issues. Treatment may involve medication to manage the condition or prevent infection, while surgery may be necessary if the colon sustains significant damage. Typically, ischemic colitis tends to resolve without intervention.

Symptoms

When symptoms occur on the right side of the abdomen, the risk of severe complications is increased compared to left-sided colitis, which is less common. People with right-sided colitis may have more underlying medical conditions, including high blood pressure, atrial fibrillation, and kidney disease. They may require surgery more frequently and have a greater risk of death.

Common symptoms of ischemic colitis may include:

• Cramping and pain in the abdomen
• Soreness in the abdomen
• Nausea
• Vomiting or loss of appetite
• Diarrhea and urge to defecate
• Passing stool with blood or blood alone
• Low-grade fever

Ischemic colitis is frequently misdiagnosed because it is easily confused with other digestive issues. If the signs and symptoms become persistent, consult a doctor immediately. It may be a medical emergency if there is an intense abdominal pain or blood in the stool. Early detection and treatment can assist to avoid serious problems.

Causes

Ischemic colitis may not have a clearly identifiable cause for reduced blood flow to the colon, but there are several factors that increase the risk of developing it. These factors include:

• Atherosclerosis, the accumulation of fatty deposits on the arterial walls.
• Disorders affecting the circulatory system, such as the heart and blood vessels, might result in decreased blood flow in the arteries that supply the colon. One of them could be obstructed by a blood clot, or it could be compressed from the outside.
• Hypotension, or low blood pressure, caused by dehydration, heart failure, surgery, trauma, or shock.
• Obstruction of the bowel caused by a hernia, scar tissue, or a tumor.
• History of surgery on the heart, blood vessels, digestive, or gynecological systems.
• Cocaine or methamphetamine consumption
• Colon cancer
• Blood-related medical conditions, such as vasculitis, lupus or sickle cell anemia
• Physical triggers such as colds
• The role of medications although uncommon, some medicines can induce low blood pressure which can lead to ischemic colitis, such as:
  • Heart and migraine medications
  • Hormone treatments, such as estrogen
  • Antibiotics
  • Pseudoephedrine
  • Opioids
  • Some irritable bowel syndrome medications
  • Chemotherapy drugs

Risk factors

Several factors can affect one’s risk of developing ischemic colitis, such as:

• Age: It primarily affects adults over the age of 60. In a young adult, ischemic colitis could be a symptom of other medical condition such as a blood clotting disorder or vasculitis.
• Sex: Women are more likely to develop ischemic colitis.
• Blood clotting issues: The most frequent genetic disorders that increase the risk of blood clotting are Factor V Leiden and prothrombin gene mutation (G20210A). These disorders may increase the risk of ischemic colitis.
• High cholesterol: can contribute to atherosclerosis which can disrupt blood flow to the colon and lead to ischemic colitis.
• Reduced blood flow: due to some illnesses, such as diabetes or rheumatoid arthritis. It can also be a result of cardiac failure, low blood pressure, or shock.
• History of abdominal surgery: Blood flow may be restricted by scar tissue incurred after an abdominal surgery.
• Heavy exercise: Strenuous exercise, such as marathon running can cause ischemic colitis by straining the heart’s ability to pump adequate blood. This is commonly known as “runner’s colitis”.
• Surgery: The aorta or main artery can increase the risk of developing ischemic colitis. The aorta transports the blood from the heart to the rest of the body.