Beyond Low Flow:
How I Manage Ischemic Colitis
Lawrence J. Brandt , MD, MACG and Paul Feuerstadt, MD, FACG
From The American Journal of Gastroenterology Red Section November 2016
THE BIG PICTURE
Colon ischemia (CI) is a common disease diagnosed in 16–24% of patients presenting to the hospital with acute lower gastrointestinal bleeding and accounting for ~16–18 per 100,000 hospital admissions. Indeed, it is the most common ischemic disorder of the GI tract, and it and infectious colitis are the most common colitides seen in patients older than 65 years of age.
Therefore, CI is important to keep in mind whenever you are consulted on an older person with bloody diarrhea, diarrhea, rectal bleeding, or abdominal pain. We prefer the umbrella term “colon ischemia” instead of “ischemic colitis” since an inflammatory phase of CI is not documented in all patients, and thus, CI is a more accurate term. The main questions we ask ourselves when approaching a patient with possible CI are: i) What are the symptoms; ii) What else could it be; iii) Should computed tomography (CT) and/or colonoscopy be performed; iv) How sick is the patient; v) Are antibiotics needed; vi) Does the patient need a surgeon?