Review Article

The Pharmacological Causes of Colon Ischaemia

Ziga Vodusek; Paul Feuerstadt; Lawrence J. Brandt


Aliment Pharmacol Ther. 2019;49(1):51-63. 

In This Article

Medical co-morbidity as the Concurrent Risk Factor for Medication-induced Colon Ischaemia

When considering pharmacologically mediated colonic ischaemia, one must also consider patients' underlying medical co-morbidities and the disease state being treated. These baseline risk factors leave some patients prone to colonic ischaemia and in these scenarios medications are a second potential triggering risk factor. The best example of this was when alosetron was first approved in 2000 for the treatment of irritable bowel syndrome with diarrhoea predominance in women and a significant number of patients developed colonic ischaemia. When studied further, it was clear that patients with IBS-alone were approximately 3.4-fold more likely to have colonic ischaemia than the general population and the addition of alosetron further contributed to the likelihood of colonic ischaemia.[6] Irritable bowel syndrome is not the only disease for which associations of causality are seen. Patients with chronic obstructive pulmonary disease frequently require corticosteroid therapy for disease exacerbation and both chronic obstructive pulmonary disease as well as corticosteroids are risk factors for colonic ischaemia. Patients with oncologic diagnoses are known to be hypercoagulable, and chemotherapeutic agents were reported in one study to be the most frequently associated pharmacologic risk factor for colonic ischaemia.[5] Digitalis is used to enhance cardiac forward flow in patients with heart failure and both the poor forward flow as well as the digitalis have been implicated in colonic ischaemia. Atherosclerosis is also a risk factor for colonic ischaemia and can increase risk further when combined with various medications. Finally, oral contraceptive pills are commonly used in young women, but this population can have irritable bowel syndrome or obesity, both risk factors for colonic ischaemia, and thus complicating any attribution of causality.[7–9] The combination of medication and medical co-morbidity risk factors have never been studied and require further attention, but it remains important at the outset to look at all risk factors for colonic ischaemia that might be present in a patient presenting with colonic ischaemia in which a pharmacologic agent is considered a potential cause. These important considerations will be outlined throughout the manuscript.