Under ischemic colitis, the medical profession describes the condition of a change in the colon, triggered due to inflammation. Sometimes, however, medications can also trigger the inflammatory change.
What is ischemic colitis?
An inflammation of the colon that results from reduced blood flow to the intestinal mucosa is referred to by physicians as ischemic colitis. In many cases, there is arteriosclerosis of the so-called mesenteric arteries as well as their branches. Diabetics in particular are frequently affected by ischemic colitis.
Causes
Stenosing arteriosclerosis of the blood vessels that subsequently supply blood to the colon is the most common cause of ischemic colitis. However, drugs can also cause ischemic colitis. Thus, the clinical picture occurred under the medication of appetite inhibitors (phentermines), cardiac glycosides (digitalis) as well as contraceptives, NSAIDs as well as chemotherapeutic agents (vinca alkaloids and taxanes). Even TNF-alpha inhibitors, which fall into the category of newer drugs, can promote ischemic colitis. Metamphetamine or cocaine abuse have also been associated with ischemic colitis. However, mechanical constriction caused by a volvulus, bride, or tumor, inflammatory swelling, or an aortic aneurysm, which can occur after surgery, also favors the formation of ischemic colitis. Another reason may be vasculitis. If there is a congenital anomaly of the anastomosis, which is located at the Drummond arcades and the Riolan anastomosis, there is a significantly increased risk of developing ischemic colitis. Protein C deficiency, AT3 deficiency, or even factor V Leiden and the prothrombin mutation can also be causes of ischemic colitis. However, the condition has also been documented in association with elite athletes; excessive marathon running in particular can promote ischemic colitis.
Symptoms, complaints, and signs
The complaints and symptoms are nonspecific and can be compared with those of other colitis. Very mild forms manifest predominantly in that the patient suffers from very thin stools or diarrhea. Intestinal cramps are also possible. However, if a severe and pronounced form of ischemic colitis exists, blood may also be present in the stool. However, hematochezia is relatively atypical. The patient’s abdomen is soft on palpation, although sometimes – when severe – defensive tenderness is possible, suggestive of transmigratory peritonitis. If a necrotizing course is present, fever develops as well as chills. In that form of ischemic colitis, there is a high mortality; in this case, the physician usually has to operate immediately.
Diagnosis and course of the disease
As part of the diagnosis, the physician performs a colonoscopy. Depending on the severity, the picture of the colonoscopy varies; sometimes there may even be a suspicion of ulcerative colitis. In a few cases, the physician also recognizes individual longitudinal ulcerations. Although these are characteristic, they can sometimes hardly be distinguished from Crohn’s disease. It is important to differentiate by histology. Thus, Crohn’s disease and also ulcerative colitis must be excluded before the physician can make the diagnosis of ischemic colitis. If severe cases of ischemic colitis are present, imaging techniques such as intestinal ultrasonography or computed tomography may also help to discuss the exact condition of the disease. The intestinal wall is already thickened; sometimes the physician can also detect gas formation in the intestinal wall (so-called pneumatosis coli). Ischemic colitis disappears after only two to three days. However, the course of the disease can also bring complications. For example, tissue may die or there may be persistent bleeding caused by intestinal perforation. Other complications include inflammation of the bowel and intestinal obstruction.
Complications
In most cases, this disease causes discomfort or complications in the stomach and intestines. Those affected often suffer from diarrhea and nausea. The quality of life is also considerably reduced by this disease. Furthermore, there are severe cramps in the stomach and abdomen, and in some cases there is also bloody stool.Not infrequently, loss of appetite is also noticeable, which can lead to underweight or deficiency symptoms. Furthermore, the affected person may also suffer from chills or fever. If there is no immediate treatment, the affected person can also die from this disease. Furthermore, intestinal obstruction or inflammation in the intestines may also occur. The treatment of this disease takes place with the help of antibiotics and can alleviate the symptoms. There are no further complications. In severe cases, however, surgical intervention may be necessary. This may further lead to heart problems or diabetes. Whether the life expectancy is limited by this, can usually not be predicted.
When should you go to the doctor?
Ischemic colitis heals on its own in many cases. A doctor should be consulted if typical symptoms such as intestinal cramps, pain in the stomach area, or diarrhea persist for more than a week. If further symptoms develop, medical advice is required in any case. In case of fever or chills, it is best to consult the family doctor. Blood in the stool is also a clear warning sign that needs to be clarified quickly. People suffering from vasculitis or tumor disease are particularly susceptible to the development of ischemic colitis. So are patients who regularly take appetite inhibitors or suffer from a protein deficiency. Anyone who belongs to these risk groups must immediately discuss the signs mentioned with the responsible physician. At the latest when underweight sets in as a result of the complaints, medical help is needed. The affected person should consult a general practitioner or a gastroenterologist. Children are best taken to a pediatrician or directly to the nearest clinic on the same day.
Treatment and therapy
In many cases, the patient does not require differential therapy; ischemic colitis heals spontaneously. If treatment is given, the physician decides based on which form of the disease is present. In mild forms of the disease, which should usually disappear after two to three days, the physician may prescribe antibiotics to prevent infection. Sometimes, if dehydration is present, intravenous fluid administration may be helpful. Medications that have the effect of constricting blood vessels should be discontinued (such as migraine medications or even hormonal pills). In the case of mild forms, the physician concentrates mainly on alleviating the symptoms. The physician will subsequently schedule so-called follow-up colonoscopies, so that he can monitor healing on the one hand and react in time if any complications arise on the other. However, if a severe form of ischemic colitis is present that has already resulted in damage to the intestine being visible, surgery may sometimes be performed. During surgery, the physician removes dead tissue, may repair a perforation of the bowel, or sometimes may place a bypass so that the artery of the bowel is no longer blocked. In a few cases, the physician also removes part of the colon. However, surgery is rarely necessary. Favoring factors that could negatively influence the course of the disease and make surgery necessary are diabetes mellitus, heart disease of any kind, or low blood pressure.
Outlook and prognosis
The prognosis of ischemic colitis is favorable in most patients. Spontaneous healing is often observed in this disease. Under normal circumstances, marked relief of symptoms or freedom from symptoms are documented within 2-3 days. In a large number of cases, no long-term complications or irregularities occur. In the short term, various discomforts may be documented, causing a deterioration in quality of life. During the course of life, ischemic colitis may recur. If the condition is caused by the administration of medication, an improvement occurs immediately after the drug is discontinued. Alternative treatment methods should be discussed in cooperation with the attending physician so that the existing underlying disease can be further treated. One problem of ischemic colitis is the differentiation from other diseases. The diagnosis is difficult due to parallel complaints to other diseases of the intestine.In patients who have already been diagnosed with other previous diseases, the general state of health must be taken into account for the prognosis. In the case of chronic diseases such as diabetes or existing heart disease, the overall prognosis worsens. There may be a need for surgical intervention in rare cases. This is associated with the usual risks and side effects. If no complications occur, an improvement in health can be expected.
Prevention
Due to the fact that the origin of ischemic colitis cannot always be clarified, no specific preventive measures are known to prevent the disease. It is advisable – if the patient belongs to the risk groups – to avoid medications that serve the purpose of reducing blood flow. Furthermore, regular exercise is recommended, as well as a check-up of the colon if underlying diseases such as diabetes mellitus or any diseases of the heart are known.
Follow-up care
The risk of ischemic colitis can be reduced during follow-up by avoiding certain medications. Therefore, those who belong to the risk group should have their medication settings reviewed by their physician and changed if necessary. In this way, it is possible to restrict the current blood flow. In the period after treatment, those affected can support the course of recovery by changing their own habits. Regular activities and close monitoring of existing underlying diseases are recommended for this purpose. These are typically diabetes or heart problems. Sometimes there is a spontaneous healing, so that further therapy is not necessary. In other cases, which are not so favorable, the doctor often prescribes antibiotics. The patient takes these exactly as prescribed. A certain amount of rest, warmth and a healthy diet rich in vitamins help to strengthen the body. The patient should also drink enough fluids to avoid dehydration. Regular doctor’s appointments ensure constant monitoring. In case of complications such as intestinal cramps or diarrhea, alternative natural remedies often help. Before taking them, it is a good idea to consult with your doctor. However, gentle remedies such as herbal tea may also be used without medical advice to treat mild gastrointestinal complaints.
What you can do yourself
In some cases, ischemic colitis heals spontaneously and requires no further treatment. In a less positive course, antibiotic treatment is indicated. This can be supported by the affected person by taking some measures. In general, the patient should take it easy and pay attention to a healthy and balanced diet. It is particularly important to drink plenty of fluids to prevent dehydration. Accompanying this, regular visits to the doctor are necessary. It may be necessary to discontinue the triggering medication or adjust it differently. If symptoms such as diarrhea or intestinal cramps occur, alternative remedies from natural medicine are recommended. In consultation with the doctor, preparations with arnica or devil’s claw, for example, can be used. Soothing herbal teas and other gentle remedies may also be used without the consent of the physician and are particularly helpful for less severe gastrointestinal complaints. In case of fever and chills, bed warmth and rest are recommended. The patient should measure his body temperature regularly and consult the doctor in case of a sudden rise. In general, if symptoms are severe, medical evaluation is needed to avoid further complications and ensure a speedy recovery.