Search

Background: In recent studies on lower gastrointestinal bleeding, ischemic colitis (IC) has been shown to be one of the most common etiologies. Despite this, data are scarce on the incidence of IC in the general population and population based studies on the epidemiology and clinical outcome of IC are largely lacking. We aimed to determine the incidence and the clinical outcome of patients with IC. Methods: All patients with a clinical suspicion of IC were identified by search in the diagnoses database (ICD-10 code K 55) and for the term "ischemic colitis" in the text of the electronic medical records in the National University Hospital of Iceland, serving a population of 151, 000 above the age of 18, between 2009 and 2012. Histological confirmation of IC was required for the diagnosis. Data on age, gender, symptomatology, smoking habits, need for surgery and mortality were analyzed. Results: A total of 74 patients, 42 (57%) females, median age 69 years (IQR 58-78), (range 23-90 years), fulfilled the clinical and histological predetermined criteria. The mean crude annual incidence was 12.3 cases per 100, 000 inhabitants: for the year 2009 (9 cases per 100, 000), 2010 (15 cases per 100, 000), 2011 (14 cases per 100, 000) and 2012 (11 cases per 100, 000 inhabitants), respectively. A total of 8/74 (11%) were younger than 50 years of age at diagnosis. During the study period, with a median follow-up of 27 months (1436), a total of 11/74 (15%) experienced a recurrent IC, 8/42 (19%) females and 3/32 (9%) males (NS). No factor was found to predict recurrence. Overall 39/74 (53%) were current smokers (n=20) or ex-smokers (n=19). Bleeding per rectum was present in 62/74 (84%) and the IC was localized in the left colon in 60/74 (81%) of the patients, 6 (8%) in the right colon, and other location in 8 cases. Overall 66/74 (89%) were managed conservatively but 6 (8%) required emergency surgery. At the end of follow-up 11/74 (15%) had died, two died from IC, three from lung cancer, one each from colon cancer and liver cirrhosis, and three of unknown cause. Among those who died 2/6 (33%) underwent surgery vs. 8/ 68 (12%) of those who could be managed conservatively (NS). Conclusions: The incidence of IC was approximately 12 cases per 100, 000 and year, which was stable during the 4year study period. In a population-based setting approximately 15% of patients with IC experienced a recurrence of IC. Overall 8% of patients required surgery and prognosis in this group was less favorable whereas those who were managed conservatively had a good prognosis. The high prevalence of smokers and ex-smokers among IC patients requires further study.