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


We performed a MEDLINE search for "colon ischemia", "colon ischaemia", "ischemic colitis" and "ischaemic colitis" in addition to the medications that have previously been associated with colonic ischaemia using the electronic database PubMed. The terms "colon ischemia", "colon ischaemia", "ischemic colitis" and "ischaemic colitis" were queried alone or in combination with "antibiotics," "AAHC," "appetite suppressants," "chemotherapeutic agents," "chemotherapeutic drugs," "constipation-induced medication," "constipation-inducing drugs," "decongestant," "digitalis," "diuretics," "ergot alkaloids," "ergot," "hormone therapy," "illicit drug," "controlled substance," "immunomodulator drugs," "immunomodulator agent," "laxative," "NSAID," "non-steroidal anti-inflammatory drug," "anti-inflammatory," "serotonin," "serotonin medication," "statin," "vasopressor," and "vasopressin." Relevant search results in this review included 180 reviews and case reports, focusing on more recent documents but also including relevant older references. When no new research or case reports were found, existing data and cases were included in the discussion. Rating the quality of the literature in a systematic way is not possible given the challenges intrinsic to studying associations between medications and colonic ischaemia, including heterogeneity of and lack of well-constructed studies. We believe that there should be some rating of the quality of the literature supporting the association. Therefore, we have rated the quality of the literature supporting associations as either "strong" or "moderate." Any association that we deemed weak was not included in this manuscript. This included single case reports, those that had too many confounding factors in the reported cases to justify any strength of association and/or those that did not provide pathologic evidence for diagnosis. These ratings are based upon our assessment of the quality of reports and hypothesised mechanisms of disease. Discussion of medications is ordered according to these ratings, the first being classes of medications with a strong association followed by those with a moderate association.