Document Detail


Epidemiology, clinical features, high-risk factors, and outcome of acute large bowel ischemia.
MedLine Citation:
PMID:  19500689     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND & AIMS: Only a limited amount of important information is available on acute lower bowel ischemia (ALBI). We investigated the epidemiology, clinical aspects, high-risk factors, and outcome of ALBI. METHODS: We retrospectively analyzed data collected from 401 patients with 424 hospitalizations with ALBI in a prepaid health system for 7 years. RESULTS: The estimated annual incidence of ALBI was 15.6/100,000 patient-years (22.6 female, 8.0 male), with a marked age-related increase. ALBI preceded 400 admissions (94%) and followed surgery or medical admission of 24 patients (6%); 307 (72%) had rectal bleeding and abdominal pain. In 417 episodes, left-sided or transverse (368, 88%) exceeded right-sided or bilateral ALBI (49, 12%). Thirty-one patients (8%) had resection; 15 died (4%). Factors that were independently associated with resection and/or death included right-sided or bilateral distribution (adjusted odds ratio [AOR], 14.64; 95% confidence interval [CI], 4.82-44.50; P < .001), onset after admission (AOR, 7.48; 95% CI, 2.19-25.54; P < .005), hypotension (AOR, 4.45; 95% CI, 1.18-16.76; P < .05), tachycardia (AOR, 4.40; 95% CI, 1.46-13.26; P < .01), warfarin use (AOR, 4.33; 95% CI, 1.21-15.47; P < .05), antibiotic therapy (AOR, 3.94; 95% CI, 1.23-12.64; P < .05), male sex (AOR, 2.65; 95% CI, 1.00-7.05; P = .05), nonsteroidal anti-inflammatory drug use (AOR, 0.15; 95% CI, 0.04-0.53; P < .005), and rectal bleeding (AOR, 0.24; 95% CI, 0.09-0.65; P < .005). During a mean of 2.6 +/- 1.9 years, no patient developed chronic colitis, and 1 (<1%) had stricture dilation. Estimated ALBI recurrence was 3%, 5%, 6%, and 10% at years 1, 2/3, 4, and 5/6, respectively. CONCLUSIONS: ALBI is common and agerelated and predominates in female patients. Demographic and clinical variables predict severe ALBI. Chronic sequelae are rare. Recurrence is substantial.
Authors:
George F Longstreth; Janis F Yao
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-06-23
Journal Detail:
Title:  Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association     Volume:  7     ISSN:  1542-7714     ISO Abbreviation:  Clin. Gastroenterol. Hepatol.     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-10-05     Completed Date:  2009-12-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101160775     Medline TA:  Clin Gastroenterol Hepatol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1075-80.e1-2; quiz 1023     Citation Subset:  IM    
Affiliation:
Department of Gastroenterology, Kaiser Permanente Medical Care Plan, San Diego, California, USA. george.f.longstreth@kp.org
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Female
Humans
Intestinal Diseases / epidemiology*,  pathology,  physiopathology,  therapy*
Intestine, Large / pathology*
Ischemia / epidemiology*,  pathology,  physiopathology,  therapy*
Male
Middle Aged
Retrospective Studies
Risk Factors
Sex Factors
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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