Diseases and Drugs That Increase Risk of Acute Large Bowel Ischemia

作者：Longstreth George F^*; Yao Janis F

来源：Clinical Gastroenterology and Hepatology, 2010, 8(1): 49-54.

DOI：10.1016/j.cgh.2009.09.006

BACKGROUND & AIMS: Information is limited on risk factors for acute large bowel ischemia (ALIN). We investigated diseases and drugs associated with ALBI. METHODS: We compared patients hospitalized with ALBI and controls through multivariate analysis or 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 H(2)-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% Cl, 2.06-4.75; P < .0001), diarrhea (AOR, 2.36; 95% Cl, 1.13-4.89; P = .0218), atrial fibrillation (AOR, 2.21; 95% Cl, 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% Cl, 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% Cl, 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.

• 出版日期2010-1