Right colonic involvement is associated with severe forms of ischemic colitis and occurs frequently in patients with chronic renal failure requiring hemodialysis

OBJECTIVE: The aim of this study was to identify factors associated with se vere outcome in patients with ischemic colitis. METHODS: The files of 60 consecutive inpatients (34 women, 26 men, mean age 67 yr) with ischemic colitis were reviewed. The following data were analyz ed: age, sex, smoking, medications, history of cardiovascular disease, meta bolic disease, chronic renal failure and hemodialysis, the time elapsed bet ween the first symptoms and the diagnosis, and the site and extension of th eir colonic involvement. Patients were divided into two groups according to outcome: those with severe disease, including those who died from ischemic colitis (n = 3) or who required surgical resection (n = 21); and those wit h mild forms of colitis who were treated successfully without surgery (n = 36). The two groups were compared by means of univariate and multivariate a nalysis to identify factors associated with unfavorable outcomes. Only pati ents who had a complete examination of the colon (n = 51) were entered into the statistical analysis. RESULTS: By univariate analysis, chronic renal failure (p = 0.03), hemodial ysis (p = 0.01), short delay between symptoms and diagnosis (p = 0.01), and right colonic involvement (p = 0.002) were significantly more common in th e patients with severe colitis. By logistic regression, right colonic invol vement was the only factor independently associated with severity (p = 0.01 ). Right-sided lesions were present in 82% of patients on dialysis but in o nly 26% of patients not on dialysis (p = 0.0005). CONCLUSIONS: Right colonic involvement is associated with severe forms of i schemic colitis and occurs frequently in patients with chronic renal failur e requiring hemodialysis. (Am J Gastroenterol 2000;95:195-198. (C) 2000 by Am. Cell. of Gastroenterology)