Ischemic Colitis Managed by Serum-Derived Bovine Immunoglobulin/Protein Isolate

Abstract

There are numerous causes of ischemic colitis, including compromised vascular circulation due to disease or certain medications which can elicit a reflex mesenteric vasoconstriction and result in diarrhea. Reported are 2 cases which detail the outcomes of including serum-derived bovine immunoglobulin/protein isolate (SBI) for the nutritional management of ischemic colitis with chronic loose and frequent stools. SBI has a unique mechanism which includes binding microbial components, maintaining normal GI immune balance, managing barrier function and improving nutrient utilization which may be useful in the management of ischemic colitis. Patient 1 was 82-year-old Caucasian female with a history of hypertension, diabetes mellitus and irritable bowel syndrome with diarrhea (IBS-D), with 4-5 bowel movements (BM)/day for 20 years. She was previously treated with dicyclomine and tricyclic antidepressants for 7 years. Her diarrhea worsened over the past 4 months to ˜10 BM/day. Because of the change in patient's chronic symptoms, a colonoscopy was performed, revealing mild to moderate colitis secondary to ischemia (Figure 1). Patient 2 was a 74-year-old African American male with ESRD/CAD/PVD admitted to hospital with an episode of rectal bleeding. Colonoscopy revealed ischemic colitis and the patient was discharged. He then developed diarrhea (5-6 BM/day). Clostridium difficile was negative by PCR so the patient was started on cholestyramine to help resolve the diarrhea but could not tolerate treatment. For both patients, SBI 5g QD was administered and the response reported here. Patient 1's BM improved to 2-3/day within 4 weeks. A repeat colonoscopy was performed 2 months after initiating SBI therapy and there was no evidence of colonic inflammation or ulcers (Figure 1). Patient 2's symptoms improved dramatically within a couple weeks, with fully formed stools (1-2 BM/day). Both patients continue on SBI 5g QD therapy for management of their condition and remain stable. Previously published reports of SBI in chronic mesenteric ischemia and other intestinal disorders support these patient observations. Although mesenteric ischemia can resolve on its own, the outcomes of these cases and the temporal nature of SBI administration suggest that these patients with ischemic colitis and associated chronic, loose stools may have benefited from this nutritional intervention. A well-controlled study in mesenteric ischemia patients is advised.Figure 1