# IBS and IBS Treatment Linked To Colonic Ischemia Risk



## Mike NoLomotil (Jun 6, 2000)

Just when you actually beleived that "IBS" could not lead to anything more serious, and all those antidiarrheals and spasmolytics were benign... ____________________Am J Gastroenterol. 2004 Jul;99(7):1333-7.Risk factors for colon ischemia.Walker AM, Bohn RL, Cali C, Cook SF, Ajene AN, Sands BE.Ingenix Epidemiology, Auburndale, Massachusetts.BACKGROUND: To identify predictors of colon ischemia, we examined demographic and clinical characteristics of patients, as well as their prior health care utilization. METHODS: Using insurance data, we identified 700 persons at least 20-yr old with presumed colon ischemia between 1995 and 1999, and 6,440 controls. Case identification was based on diagnosis and procedure codes in insurance claims for which we used a previously reported, validated algorithm. We ascertained preceding medical diagnoses and the use of drugs and health services from the insurance claims files. RESULTS: Patients with colon ischemia were nearly three times as likely to have IBS than controls. A history of nonspecific colitis, lower gastrointestinal tract hemorrhage, systemic rheumatologic disorders, and ischemic heart disease in the preceding 6 months, and abdominal surgery in the past month were also much more common in colon ischemia cases than controls. Use of a drug to treat diarrhea was strongly associated with risk. The most prevalent risk factor for colon ischemia was the use of drugs with a side effect of constipation, found in one-third of cases and one in nine controls. Cases had seen physicians, particularly gastroenterologists, much more commonly in the preceding 6 months than had controls. CONCLUSIONS: Clinically evident colon ischemia arises preferentially in persons with prior abdominal complaints, many of whom carry a diagnosis of IBS. Drugs that reduce bowel motility may constitute a widespread and potentially avoidable risk factor. The frequency of preceding doctor visits, without a specific diagnosis, suggests that colon ischemia may have a prolonged subacute presentation.______________Res Ipsa Loquitur...lifestyle modification treatment starts to look a lot less risky.MNL


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## Kathleen M. (Nov 16, 1999)

This looks like the study leading up to the one you found.The rates of this issue are still pretty low even in IBSers (some 40 per 100,000 person-year)So even if you can't do it by lifestyle alone and need medications, the risk is still low for IBSers overall.Something in the paper as a whole to think about is that there may be some chance that people with vascularization of the colon problems may show up as IBSers, more often than they are "normal" but really have this other issue and they are the ones that get ischemia.Am J Gastroenterol. 2004 Mar;99(3):486-91. Related Articles, Links Occurrence of colon ischemia in relation to irritable bowel syndrome.Cole JA, Cook SF, Sands BE, Ajene AN, Miller DP, Walker AM.Ingenix Epidemiology, Newton, Massachusetts 02466, USA.OBJECTIVE: In November 2000, alosetron HCl (Lotronex), a treatment for irritable bowel syndrome (IBS), was removed from the U.S. market in part because of the occurrence of colon ischemia in treated patients. Since the relation between colon ischemia and IBS is poorly understood, we evaluated the incidence of colon ischemia among people with and without IBS. METHODS: Using medical claims data from a large health care organization in the United States, we identified 87,449 people with an IBS diagnosis between January 1995 and December 1999. We calculated age- and sex-specific incidence rates in the general population and in IBS patients. RESULTS: There were 740 cases of colon ischemia during 8.5 million person-years of observation in 5.4 million persons. The crude incidence rate was 42.8 cases per 100,000 person-years for IBS patients. By comparison, the incidence rate was 7.2 per 100,000 person-years in the general population. After adjustment for age, sex, and calendar year, the incidence of colon ischemia in people with IBS was 3.4 times higher than in persons without (95% CI 2.6-4.5). CONCLUSIONS: Rates of colon ischemia among patients carrying a diagnosis of IBS are substantially higher than in the general population. Colon ischemia, though unusual in IBS patients, may nonetheless constitute a distinct part of the IBS natural history. Alternatively, it may be a consequence of therapy, or a manifestation of other bowel pathology that is sometimes confused with IBS.


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## Mike NoLomotil (Jun 6, 2000)

Yup that is the precendent "survey of dx codes"...as you knwo they get raw data begin torturing it, then publish some newe conclusison every time it squeeks an answer. In this case it is a bit worrisome if we think it through..."Something in the paper as a whole to think about is that there may be some chance that people with vascularization of the colon problems may show up as IBSers,"yeah that is kind of the most scary part, from the perspective of patients going undetected..."The frequency of preceding doctor visits, without a specific diagnosis, suggests that colon ischemia may have a prolonged subacute presentation."The incidence seems low but that is often a function of this study design (surveys of diagnosis codes from insurance claims). Once the problem becomes severe enough to manifest itself to the primary care provider how far along will the patient be? Because the early symptomology is vague, and it is most certainly not a condition the primary care provider is geared to looking for, retrospective analysis of claims data is often misleading.What it does tell us is how often it shows up as an assigned diagnosis code...this may be more reflective of a physicians skill in ecognizing the condition than it is of the frequency in the population. What it does not tell us is the actual occurrence, which may be many many times higher. It is not commonly on the list of things to rule out when cases like these (us) present in the PC environment. Since it has not until now been associated with anything so common as use of antidiarrheals and spasmolytics there has been no cause to even think of it much.Yow...Think about how many people pop antidiarrheals like OTC Immodium daily as a matter of routine.Yikes I think about myself all those years!MNL


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