Ischaemic colitis

The theory underlying the pathophysiology of ischaemia-reperfusion injury, and the role of free radicals in this process has been discussed in detail above. The human colon contains relatively little XO (Parks and Granger, 1986) and so the arguments supporting a role for this enzyme in the pathogenesis of small bowel 

There is some support for a role for free radicals in the pathogenesis of ischaemic colitis from animal studies. Murthy and Qi (1992) used a spin trap to demonstrate increased production of free radicals up to 60 min after reperfusion, whereas Douglas etal. (1989) demonstrated increases in malondialdehyde and conjugated dienes (presumptive measures of lipid peroxidation) in a rat model of ischaemic colitis. There is no data relating to human ischaemic colitis. 

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Papi C, Candia S, Masci P, Ciaco A, Montanti S, Capurso L. Acute ischaemic colitis following intravenous cocaine use. Ital J Gastroenterol Hepatol 1999 31(4) 305-7. 

Garcia B, Ramaholimihaso F, Diebold MD, Cadiot G, Thiefin G. Ischaemic colitis in a patient taking meloxicam. Lancet 2001 357(9257) 690. 

An isolated report describes ischaemic colitis when a patient taking tramadol took a decongestant containing pseudoephedrine. 

Although data are limited, the minor to modest possible ineieases in frov-atriptan, naratriptan, sumatriptan and zoimitriptan pharmacokinetics described are not likely to produce clinically relevant adverse effects. Almotriptan, rizatriptan and sumatriptan do not appear to have any clinically important effect on levels of contraceptive steroids. The significance of the single case report of ischaemic colitis associated with concurrent use of naratriptan and a combined oral contraceptive is unclear. Note that ischaemic colitis has, rarely, been reported with naratriptan itself The manufacturers have found no cases of ischaemic colitis in approximately 450 women on oral contraceptives and taking naratriptan for prophylaxis for 5 to 6 days. However, caution may be needed with concurrent use in those patients with risk factors for ischaemic colitis, such as those with a history of abdominal surgery, low blood pressure, diabetes, cardiovascular disease or stroke. 

Elderly people with diverticulosis may also have diffuse atherosclerotic vascular disease and thus are also at risk for ischaemic colitis. Ischaemic colitis is found frequently on the left side. Often the thickening is sharp bordered to the normal colon. A thickening with diminished vascularisation is highly suspicious for ischaemic colitis however, colour signals in a thickened bowel loop do not exclude ischaemia, since non-occlusive ischaemia may be present. 

Martson A, Pheils MT, Thomas ML, Morson BC (1966) Ischaemic colitis. Gut 7 1-15... 

The PMC can be differentiated from other coliti-des (ischaemic colitis and inflammatory colitis) when colonic wall changes are evaluated. These sonographic colonic wall changes include the wall thickness, the presence of wall stratification, detection of mural flow, the visualisation of the haustration and the localisation of the disease along the colon (Table 13.1 Truong et al. 1998 Danse et al. 2004 Danse et al. 2005). 

Ischaemic colitis Left colon >right colon 9 50% 60... 

Klestov, A., Kubler, P, and Meulef J. 2001. Recurrent ischaemic colitis associated with pseudoephedrine use. Intern Med J, 31(3) 195-196. 

Salk, A., Stobaugh, D.J., Deepak, R, and Ehrenpreis, E.D. 2013. Ischaemic colitis in rheumatoid arthritis patients receiving tumour necrosis factor-a inhibitors an analysis of reports to the US FDA adverse event reporting system. Drug Sqf, 36 329-334. 

Lewis JH. The risk of ischaemic colitis in irritable bowel syndrome patients treated with serotonergic therapies. Drug Saf 2011 34 545-65. 

Gastrointestinal Ischaemic colitis has been associated with phenothiazine antipsychotics, clozapine and olanzapine likely due to anticholinergic activity [179 ]. 

A 27-year-old man developed severe ischaemic colitis of descending and sigmoid colon after 2 weeks of treatment... 

Gastrointestinal A case of pseudo-inflammatory bowel disease in a 34-year-old male on quetiapine, with previous recent history of ischaemic colitis with clozapine is reported [222 ]. 

Ajani S, Hurt RT, Teeters DA, BeUmore LR. Ischaemic colitis associated with oral contraceptive and bisacodyl use. BMJ Case Rep 2012 2012. pu bcrl220115451. 

Ischaemic colitis After 19 weeks of treatment with pegylated IFNa-2a and ribavirin for chronic hepatitis C genotype lb, a 48-year-old woman developed severe abdominal pain with haematochezia. CT, colonoscopy and colonic mucosal biopsy led to a diagnosis of ischaemic colitis. After discontinuation of the IFN-ribavirin therapy, the symptoms subsided and mucosal ulceration improved. A munber of cases of ischaemic colihs during IFN therapy have been reported, all of which involve the descending colon [46 ]. 

Two further cases of ischaemic colitis dining IFN treatment of chronic hepatitis C were fully healed within 1 week after symptoms onset and withdrawal of pegylated lFNa-2b. Upon resumption of IFN therapy, ischaemic colihs did not recur and a sustained anhviral response was maintained in both pahents [47 ]. 

Kawaguchi T, Ide T, Itou M, Suetsugu M, Yoshioka S, Sakata M, et al. Ischaemic colitis during interferon treatment for chronic hepatitis C report of two cases and literature review. J Viral Hepat 2012 19(2) e220-4. 

SaUc A, Stobaugh DJ, Deepak P, Ehrenpreis ED. Ischaemic colitis with type I interferons used in the treatment of hepatitis C and multiple sclerosis an evaluation from the food and drug administration adverse event reporting system and review of the literature. Ann Pharmaco-ther 2013 47(4) 537.A2. 

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