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Ristilblóðþurrð hjá ungu fólki

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L1997-06-83-F2.pdf
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Authors
Hjörtur Kristjánsson
Þorgeir Þorgeirsson
Nick Cariglia
Issue Date
1997-07-01

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Ischemic colitis in young adults
Citation
Læknablaðið 1997, 83(6):374-81
Abstract
Introduction: Ischemic colitis is most often considered a disease of the elderly with associated cardiovascular disease. Young patients with this disease have been diagnosed at our hospital and therefore the authors decided to investigate the disease's prevalence, its anatomical location, prognosis and risk factors in the young population. Material and methods: A retrospective search of all cases diagnosed as ischemic colitis from 01.01. 1983 to 31.12. 1995 was performed. One author (ÞÞ) reviewed all pathological material. Strong inclusion criteria were proposed and of the 50 cases discovered, only 26 fulfilled these strict criteria, 16 women and 10 men. Five were under the age of 40 (19%), three of them men. Results: Ischemia was most common in the left colon. Incidence has increased in the last years, paralelling the increase in colonoscopies performed. All patients under 40 years of age had completely reversible ischemia, however eight of 21 patients over the age of 60 required surgical intervention. Five patients died and were all older than 75 years. The percentage of young patients is noteworthy. Conclusion: Pathophysiology of ischemic colitis in young people is in most cases unknown. Possible contributing factors in our study were smoking, dehydration, NSAID (non-steroidal anti-inflammatory drugs) use, constipation and contraceptive use. The study supports the importance of early endoscopy and biopsies for diagnosis in patients presenting acutely with symptoms of hemorrhagic colitis.
Inngangur: Ristilblóðþurrð hefur fyrst og fremst verið talin sjúkdómur eldra fólks með hjarta- og æðasjúkdóma. Ungt fólk hefur greinst með þennan kvilla á Fjórðungssjúkrahúsinu á Akureyri (FSA) og því þótti höfundum ástæða til að kanna algengi hans hjá yngra fólki, staðsetningu, sjúkdómsgang, áhættuþætti og afdrif. Efniviður og aðferðir: Leituð voru uppi öll tilfelli á tímabilinu 01.01. 1983 til 31.12. 1995. Einn höfunda (ÞP) endurskoðaði öll sýnin. Sett voru strong skilyrði fyrir greiningu og af 50 sjúklingum upphaflega athuguðum reyndust 26 uppfylla þau skilyrði, 16 konur og 10 karlar. Fimm voru yngri en 40 ára (19%), þar af þrír karlar. Niðurstöður: Blóðþurrð var algengust í vinstri hluta ristils. Tíðni hefur aukist síðustu ár, samhliða fjölgun ristilspeglana. Allir sjúklingar yngri en 40 ára voru með afturkvæma ristilbólgu, en átta af 21 eldri en 60 ára gengust undir aðgerð. Fimm dóu og voru þeir eldri en 75 ára. Hlutfall yngri sjúklinga er athyglisvert. Ályktun: Meinmyndun ristilblóðþurrðar hjá ungu fólki er illa skilgreind í flestum tilfellum. Mögulegir áhættuþættir hjá okkar sjúklingum voru meðal annars estrogen, bólgueyðandi gigtarlyf (NSAID), þurrkur, astmi, aukinn þrýstingur í kviðarholi, reykingar, ampicillín og hugsanlega E. coli, 0157:H7. Rannsókn okkar styður mikilvægi skjótrar speglunar og vefjaskoðunar til greiningar sjúklinga með bráðan og blóðugan niðurgang.
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