Ischemic Colitis

Under ischemic colitis, doctors describe the condition of a change in the large intestine caused by inflammation. Sometimes, however, medication can also trigger the inflammatory change.

Ischemic Colitis

What is ischemic colitis?

According to, inflammation of the large intestine, which results from reduced blood flow in the intestinal mucosa, is what doctors call ischemic colitis. In many cases there is arteriosclerosis of the so-called mesenteric arteries and their branches. Diabetics in particular are often affected by ischemic colitis.


The stenosing arteriosclerosis of the blood vessels that subsequently supply blood to the large intestine is the most common cause of ischemic colitis. But medications can also cause ischemic colitis. The clinical picture occurred under the medication of appetite inhibitors (phentermines), cardiac glycosides (digitalis) as well as contraceptives, NSAIDs and chemotherapeutic agents (vinca alkaloids and taxanes).

Even TNF-alpha inhibitors, which fall into the category of newer drugs, can contribute to ischemic colitis. Methamphetamine and cocaine abuse have also been linked to ischemic colitis. However, mechanical constrictions caused by a volvulus, bridles or tumor, inflammatory swelling or an aortic aneurysm, which can occur after an operation, favor the formation of ischemic colitis.

Another reason can also be vasculitis. If there is a congenital anomaly, which is located at the Drummond arcades and the Riolan anastomosis, there is a clearly elevated oneriskbefore getting ischemic colitis. Protein C deficiency, AT3 deficiency or Factor V Leiden and the prothrombin mutation can also be causes of ischemic colitis.

However, the disease has also been documented in connection with top athletes; in particular, excessive marathon running can promote ischemic colitis.

Symptoms, Ailments & Signs

As part of the diagnosis, the doctor performs a colonoscopy.
© Kateryna_Kon–

The complaints and symptoms are non-specific and can be compared with those of other colitis. Very mild forms manifest primarily in that the patient suffers from very loose stools or diarrhea. Intestinal cramps are also possible. However, if there is a severe and pronounced form of ischemic colitis, there may also be blood in the stool.

However, hematocechiae is relatively untypical. The patient’s abdomen is soft on palpation, although sometimes – in severe cases – defensive tensions are possible, which indicate a migration peritonitis. If there is a necrotizing course, fever and chills develop. There is a high mortality rate in that form of ischemic colitis; here, the doctor usually has to operate immediately.

Diagnosis & course of disease

As part of the diagnosis, the doctor performs a colonoscopy. Depending on the severity, the colonoscopy picture varies; sometimes there may even be a suspicion that ulcerative colitis exists. In a few cases, the doctor also recognizes individual longitudinal ulcerations. Although these are characteristic, they can sometimes hardly be distinguished from Crohn’s disease.

It is important that differentiation is based on histology. Thus, Crohn’s disease and also ulcerative colitis must be ruled out before the doctor can diagnose ischemic colitis. If there are severe cases of ischemic colitis, imaging methods such as intestinal sonography or computer tomography can also help to discuss the exact condition of the disease. The intestinal wall is already thickened; sometimes the doctor can also detect gas formation in the intestinal wall (so-called pneumatosis coli).

Ischemic colitis disappears after two to three days. However, the course of the disease can also bring complications. Among other things, tissue can die or persistent bleeding caused by intestinal perforation can occur. Other complications include intestinal inflammation and intestinal obstruction.


In most cases, this disease causes symptoms or complications in the stomach and intestines. Those affected often suffer from diarrhea and nausea. The quality of life is also significantly reduced by this disease. There are also severe cramps in the stomach and abdomen, and in some cases bloody stools.

It is not uncommon for a loss of appetite to become noticeable, which can lead to underweight or deficiency symptoms. Those affected can also suffer from chills or fever. If there is no immediate treatment, the person affected can also die from this disease. Furthermore, it can also lead to an intestinal obstruction or inflammation in the intestine.

The treatment of this disease takes place with the help of antibiotics and can relieve the symptoms. There are no further complications. In serious cases, however, an operation may be necessary. It can also lead to heart problems or diabetes. It is generally not possible to predict whether life expectancy will be reduced as a result.

When should you go to the doctor?

In many cases, ischemic colitis heals on its own. A doctor should be consulted if typical symptoms such as intestinal cramps, epigastric pain or diarrhea persist for more than a week. If other symptoms appear, medical advice is required in any case. If you have a fever or chills, it is best to see your family doctor. Blood in the stool is also a clear warning sign that needs to be clarified quickly.

Individuals suffering from vasculitis or a tumor disease are particularly susceptible to the development of ischemic colitis. Likewise, patients who regularly take appetite suppressants or suffer from a protein deficiency. Anyone who belongs to these risk groups must discuss the symptoms mentioned immediately with the responsible doctor. Medical help is needed at the latest when you become underweight as a result of the symptoms. The person concerned should consult a general practitioner or a gastroenterologist. Children are best taken to a pediatrician or directly to the nearest clinic on the same day.

Treatment & Therapy

In many cases the patient does not require any different therapy; ischemic colitis heals spontaneously. If treatment is given, the doctor decides what form of the disease is present. In the case of mild forms of the disease, which should usually disappear after two to three days, the doctor can prescribe antibiotics to prevent infection.

Sometimes, if dehydration is present, giving fluids intravenously can help. Medicines that have the effect of constricting blood vessels should be discontinued ( e.g. migraine medicines or hormonal tablets). In mild forms, the doctor focuses primarily on relieving the symptoms.

The doctor will then plan so-called follow-up colonoscopies so that he can monitor healing and react in good time if any complications arise. However, if there is a severe form of ischemic colitis that has already caused damage to the intestines to be seen, surgery can sometimes be performed.

During the operation, the doctor removes dead tissue, can repair a perforation in the intestine, or sometimes place a bypass so that the artery of the intestine is no longer blocked. In a few cases, the doctor also removes part of the large intestine.

However, surgeries are rarely necessary. Favoring factors that negatively influence the course of the disease and could make an operation necessary are diabetes mellitus, heart disease of any kind or low blood pressure.

Outlook & Forecast

The prognosis of ischemic colitis is favorable in most patients. Spontaneous healing is often observed in this disease. Under normal circumstances, a significant alleviation of symptoms or freedom from symptoms is documented within 2-3 days. In a large number of cases, there are no long-term complications or irregularities. In the short term, various complaints can be documented that cause a deterioration in the quality of life. Ischemic colitis can recur over the course of life.

If the disease is caused by the administration of drugs, the situation improves immediately after stopping the drug. Alternative treatment methods should be discussed in cooperation with the doctor treating you so that the existing underlying disease can continue to be treated.

One problem with ischemic colitis is its differentiation from other diseases. The diagnosis is difficult due to parallel symptoms to other diseases of the intestine. In the case of patients who have already been diagnosed with other pre-existing conditions, the general state of health must be taken into account when making the prognosis. In the case of chronic diseases such as diabetes or an existing heart disease, the overall prognosis worsens. In rare cases, surgical intervention may be necessary. This is associated with the usual risks and side effects. If there are no complications, an improvement in health can be expected.


Due to the fact that the development of ischemic colitis cannot always be clarified, no specific preventive measures are known to prevent the disease. It is advisable – if the patient is one of the risk groups – to avoid drugs that serve the purpose of reducing blood flow.

Regular exercise and an examination of the colon are also recommended if underlying diseases such as diabetes mellitus or any heart diseases are known.


The risk of ischemic colitis can be reduced during follow-up by not using certain medications. Anyone who belongs to the risk group should therefore have their doctor check their medication settings and change them if necessary. In this way, it is possible to restrict the current blood flow. In the time after the treatment, those affected can support the recovery process by changing their own habits.

Regular activities and close monitoring of existing underlying diseases are recommended for this. This is typically diabetes or heart problems. Sometimes it heals spontaneously, making further therapy unnecessary. In other cases that don’t go so well, the doctor often prescribes antibiotics.

The patient takes it exactly as directed. A certain rest, warmth and a healthy, vitamin-rich diet help to strengthen the body. The patient should also drink enough fluids to avoid dehydration. Regular doctor’s appointments ensure constant monitoring.

Alternative natural remedies often help with complications such as intestinal cramps or diarrhea. Before taking it, it makes sense to consult with your doctor. However, gentle remedies such as herbal tea may also be used without medical advice to treat mild gastrointestinal complaints.

You can do that yourself

In some cases, ischemic colitis resolves spontaneously and requires no further treatment. If the course is less positive, antibiotic treatment is indicated. This can be supported by the person concerned with a number of measures.

In general, the patient should take it easy and pay attention to a healthy and balanced diet. It is important to drink plenty of fluids to prevent dehydration. In addition, regular visits to the doctor are necessary. The triggering drug may have to be stopped or adjusted differently. If symptoms such as diarrhea or intestinal cramps occur, alternative remedies from naturopathy are recommended. In consultation with the doctor, for example, preparations with arnica or devil’s clawbe applied. Soothing herbal teas and other gentle remedies may also be used without the doctor’s consent and help, above all, with less severe gastrointestinal complaints.

Warmth and rest in bed are recommended for fever and chills. The patient should regularly measure his body temperature and in case of a sudden increase consult the doctor. In general, severe symptoms require medical evaluation to avoid further complications and to ensure a speedy recovery.