Ischemic colitis

[dc777]

I am 38 yr. old female and was diagnosed with Ischemic Colitis.  I was admitted 2 months ago into the Hospital for 3 days.  Prior to the Acute onset, I had diarrhea for 4-5 weeks (which I attributed to stress). I also was taking sinus pills almost daily, like Tylenol Sinus ect.  I have never been a big water drinker so I am pretty sure I was dehydrated.  I have not been on birth control for over 8 years.  I do have low blood pressure.  I just had that checked at the beginning of 05 I was told not really low enough to be a problem. I do smoke.  I am not a marathon runner (I do exercise).  Drink a lot of caffeine, no alcohol.  I did take Metabolife at the beginning of 2000 for about 6 months to a year.
Don't know if diet pills can play a role in this problem.

I have had a pain in my lower left side for almost 5 years.  At times it feels like a sharp burning pain, other times like a dull ache, or just sore.  The pain is daily.  I had the Gyno tests done and everything came back ok.  Also, I have noticed that I seem to urinate a lot more frequently this has been going on for a couple years.  Also, my stomach seems to growl empty or full.  Prior to my hospitalization I went to see my PCP who continually dismissed my problems as "age related."

Since my discharge from the Hospital, I still have the dull/sore ache in my left side.  Somewhat loose stools once a day (not diarrhea), and growling stomach.

I have read numerous articles and they all give the same symptoms for the Acute on set of Ischemic Colitis.  What are the symptoms prior to the severe symptoms?

How long does it take to get over the affects of the Acute on set of Colitis?

How do you know if it is Chronic?

What are the signs and symptoms of Chronic Ischemic colitis?

Is there something that can closely mimic Ischemic colitis?

Are there certain foods I should avoid?  
(I have noticed milk, and Ice cream have started to bother me.)

Are there foods I should eat?

Can I take multi-vitamins, and vitamin B?

Is a follow-up Colonoscopy necessary?

[Kevin Pho, MD]

To answer your questions:
1) Acute ischemic colitis should resolve relatively quickly (within 24-48 hours) as long as the arterial occlusion has been appropriately cleared.

2) Diagnosis can be made based on the physical exam, imaging studies or colonscopy.  More invasive studies can be done - such as angiography or laparoscopy - if the diagnosis remains unclear.

3) The signs and symptoms can vary.  Rapid onset of abdominal pain over the affected bowel as well as rectal bleeding or bloody diarrhea can occur.

4) Other possibilities can include diverticulitis or inflammatory bowel disease.

5) Normally with bowel diseases, a clear liquid diet or bowel rest is prescribed until the diagnosis is more concrete.

6) Discussion with your personal physician should be made regarding vitamins.  I cannot make specific recommendations over the internet.

7) A colonoscopy can be considered if the diagnosis continues to be unclear after imaging studies (i.e. a CT scan).

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
http://www.straightfromthedoc.com

[Sarah Connors]

The following are my personal views & advice based solely on my experience.

• Provided that the diagnosis is correct, treatment of acute episode shouldn’t take more than 24-36 hrs at the max.
• When one needs regular meds to counter the disabling, troublesome, non life threatening symptoms, colonic mucosa shows permanent changes, one has to adapt the life style/ dietary habits to live with the disease it is than when it becomes chronic. If they are not adhered too, an acute episode erupts.
• Abdominal pain after eating (abdominal angina), diarrhea with or without mucus / blood, general muscle weakness, lethargy are features of chronic ischemic colitis.
• Fatty & milk products should preferably be avoided.
• Inflammatory bowel diseases, IBS, Diverticulitis all can mimic ischemic colitis.
• There is no harm in taking Vit supplements, since most are absorbed from 1st /2nd part of duodenum & upper jejunum except for vit B which is absorbed from the caecal area. In my personal experience no adverse effect is seen even in taking Vit B supplements.
• Celiac axis Angiography is the technique of choice to confirm a clinical diagnosis.
• Follow up Colonoscopy is helpful so see if the colonic mucosa is regenerating or still atrophied & for the doc to analyze, modulate his treatment options.
• Just like atherosclerotic plaques in other organ vessels take all measures to arrest the growth of the obstruction/s, in the inferior mesenteric artery/braches, not allowing it/them to progress.
• Regular exercise, control serum lipids if high, try quitting or decrease your nicotine intake.
• Discuss the role of using blood thinners with your treating doc, in your specific case.