Diseases and Drugs That Increase Risk of Acute Large Bowel Ischemia

Background & Aims

Information is limited on risk factors for acute large bowel ischemia (ALBI). We investigated diseases and drugs associated with ALBI.

Methods

We compared patients hospitalized with ALBI and controls through multivariate analysis of prior outpatient/emergency department/inpatient diagnoses and pharmacy dispensing records.

Results

There were 379 cases and 1516 controls (median age, 69 y; range, 25–97 y; 74.4% female). Disorders that were diagnosed in more cases than controls, based on univariate analysis (P < .05), included hypertension, diabetes, chronic obstructive pulmonary disease, atrial fibrillation, congestive heart failure, depression, asthma, coronary artery disease, dementia, rheumatoid arthritis, irritable bowel syndrome, dialysis dependency, diarrhea, and constipation. Drugs dispensed to more cases than controls were antihypertensives, opioids, statins, female hormones, potentially constipating drugs, histamine H2-antagonists, immunomodulators, digoxin, clopidogrel/ticlopidine, taxanes/vinca alkaloids, and antibiotics. In all cases, ALBI was associated independently with hypertension (adjusted odds ratio [AOR], 3.21, 95% confidence interval [CI]; 2.28–4.53; P < .0001), chronic obstructive pulmonary disease (AOR, 3.13; 95% CI, 2.06–4.75; P < .0001), diarrhea (AOR, 2.36; 95% CI, 1.13–4.89; P = .0218), atrial fibrillation (AOR, 2.21; 95% CI, 1.34–3.64; P = .0019), congestive heart failure (AOR, 1.94; 95% CI, 1.11–3.39; P = .0205), diabetes (AOR, 1.82; 95% CI, 1.31–2.53; P = .0004), antibiotics (AOR, 3.30; 95% CI, 2.19–4.96; P < .0001), opioids (AOR, 1.96; 95% CI, 1.43–2.67; P < .0001), and potentially constipating drugs (AOR, 1.75; 95% CI, 1.25–2.44; P = .0012). Analysis of only women revealed similar associations except for diarrhea plus rheumatoid arthritis (AOR, 3.27; 95% CI, 1.07–9.96; P = .0370), irritable bowel syndrome (AOR, 2.72; 95% CI, 1.04–7.14; P = .0424), and female hormones (AOR, 1.88; 95% CI, 1.30–2.73; P = .0009).

Conclusions

Heterogeneous diseases and drugs increase the risk of ALBI, consistent with multifactorial pathogenesis.

Abbreviations used in this paper: ALBI, acute large-bowel ischemia, AOR, adjusted odds ratio, CI, confidence interval, IBS, irritable bowel syndrome, ICD-9-CM, International Classification of Diseases, 9th Revision, Clinical Modification, KPMCP, Kaiser Permanente Medical Care Plan, NSAID, nonsteroidal anti-inflammatory drug.