Original article
Alimentary tract
A Population-based Study of Incidence, Risk Factors, Clinical Spectrum, and Outcomes of Ischemic Colitis

https://doi.org/10.1016/j.cgh.2014.07.061Get rights and content

Background & Aims

Little is known about progression of ischemic colitis (IC) among unselected patients. We aimed to estimate the incidence, risk factors, and natural history of IC in a population-based cohort in Olmsted County, Minnesota.

Methods

We performed a retrospective population-based cohort and nested case-control study of IC. Each IC case was matched to 2 controls from the same population on the basis of sex, age, and closest registration number. Conditional logistic regression, the Kaplan–Meier method, and proportional hazards regression were used to assess comorbidities, estimate survival, and identify characteristics associated with survival, respectively.

Results

Four hundred forty-five county residents (median age, 71.6 years; 67% female) were diagnosed with IC from 1976 through 2009 and were matched with 890 controls. The age-adjusted and sex-adjusted incidence rates of IC nearly quadrupled from 6.1 cases/100,000 person-years in 1976–1980 to 22.9/100,000 in 2005–2009. The odds for IC were significantly higher among subjects with atherosclerotic diseases; odds ratios ranged from 2.6 for individuals with coronary disease to 7.9 for individuals with peripheral vascular disease. Of IC cases, 59% survived for 5 years (95% confidence interval, 54%–64%), compared with 90% of controls (95% confidence interval, 88%–92%). Age >40 years, male sex, right-sided colon involvement, concomitant small bowel involvement, and chronic obstructive pulmonary disease were all independently associated with mortality (P < .05).

Conclusions

The incidence of IC increased during the past 3 decades in a population-based cohort in Minnesota. IC typically presents in older patients with multiple comorbidities and is associated with high in-hospital mortality (11.5%) and rates of surgery (17%).

Section snippets

Study Setting and Design

By using the resources of the Rochester Epidemiology Project (REP),9 we performed this population-based study in Olmsted County, Minnesota (population, 144,260 per 2010 U.S. census)10, 11 (Supplementary Materials). We developed a detailed protocol that included the hypothesis, definition of IC, risk factors, and all analytic procedures including sample size calculations before performing the study as recommended for high-quality studies.12 We followed the STROBE checklist for reporting our

Demographics and Clinical Features of Ischemic Colitis

Between 1976 and 2009, 451 Olmsted County residents were first diagnosed with IC. Six patients (1.3%) withheld research authorization. Of the 445 patients, 67% of the IC patients were women. The median age of diagnosis was 71.6 years (range, 21.6–96.9 years), and 74% were older than 60 years at the time of diagnosis of IC. Patients usually presented with abdominal pain (73%), diarrhea (61%), rectal bleeding (71%), and abdominal tenderness (60%). Various diagnostic methods were used to diagnose

Discussion

In this population-based study of unselected community patients, the overall annual incidence of IC between 1976 and 2009 was 16 cases per 100,000 person-years. There was a 100-fold difference in incidence between county residents younger than 40 years and those aged 80 years or older. The age-adjusted and sex-adjusted incidence of IC nearly quadrupled during the course of 34 years from 6.1 cases per 100,000 person-years in 1976–1980 to 22.9 per 100,000 person-years in 2005–2009. Previous

Acknowledgments

The authors thank Debra A. Jewell, RN and Lawrence J. Timmons for their assistance in data abstraction.

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    This article has an accompanying continuing medical education activity on page e41. Learning Objective–Upon completion of this activity, successful learners will be able to evaluate temporal trends in incidence, risk factors, recurrence, and mortality in a population-based cohort of patients with ischemic colitis.

    Conflicts of interest This author discloses the following: Dr Loftus has received research support from GlaxoSmithKline. The remaining authors disclose no conflicts.

    Funding Supported in part by the Mayo Foundation for Medical Education & Research, an investigator-initiated grant from GlaxoSmithKline, and made possible by the Rochester Epidemiology Project (grant number R01 AG034676 from the National Institute on Aging). Dr Maneesh Dave was supported by an Inflammatory Bowel Disease Working Group research award.

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    Authors share co-first authorship.

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