Medicines for Ischaemic colitis

What it is

Ischaemic colitis is inflammation and injury of part of the large bowel (colon) caused by a temporary reduction in its blood supply, so that a segment of the colon does not get enough oxygen for a time. It is the most common form of reduced blood flow affecting the bowel, and is different from (and generally much less severe than) acute mesenteric ischaemia affecting the small bowel. It is most common in older people, and often there is no single obvious cause, though it can be related to a temporary drop in blood flow (for example with dehydration, low blood pressure, or after certain events), narrowed blood vessels, certain medicines, and other factors. The typical symptoms come on fairly suddenly and include tummy pain (often on the left side, and often cramping), an urgent need to open the bowels, and diarrhoea that is often mixed with blood (or the passage of blood or bloody stool). Reassuringly, the majority of cases are mild ("non-gangrenous") and the bowel recovers on its own with supportive treatment over days, as the blood flow returns. However, a minority of cases are more severe (where the bowel is more seriously damaged), which need more intensive treatment and sometimes surgery. Because bloody diarrhoea and tummy pain have several possible causes (some serious), ischaemic colitis is assessed to confirm the diagnosis.

How it is treated

Ischaemic colitis is assessed and, in most cases, managed supportively, as the majority of cases are mild and the bowel recovers on its own. Assessment includes examination, blood tests, and imaging (such as a CT scan), and often a camera examination of the bowel (colonoscopy) to confirm the diagnosis and exclude other causes of the symptoms. For the common, milder cases, treatment is supportive: resting the bowel (sometimes stopping eating for a short time), giving fluids to maintain hydration and blood flow, treating any underlying factor (such as dehydration, low blood pressure, or reviewing a responsible medicine), and monitoring; antibiotics are sometimes used. Most people improve over a few days as the blood supply and bowel recover, and follow-up may be arranged to confirm healing. Any underlying cardiovascular risk factors are addressed to reduce the chance of recurrence. For the minority with more severe disease — where there are signs that the bowel is more seriously damaged (such as severe or persistent pain, worsening illness, or evidence of the bowel not recovering) — more intensive treatment and, sometimes, surgery to remove the damaged segment are needed. The reassuring message is that ischaemic colitis is usually a mild condition that settles with supportive care as the blood flow returns, though it is assessed to confirm the diagnosis and to identify the minority of more severe cases that need more treatment.