S563 Post-Colon Ischemia Irritable Bowel Syndrome: A Multi-Center Prospective Study

Abstract

Introduction: Colon ischemia (CI) is the most common form of intestinal ischemic injury and is a common cause of acute lower gastrointestinal bleeding. Post-infection irritable bowel syndrome (IBS) is a well-described entity that occurs in up to 20% of patients after an episode of infectious colitis and IBS is almost 5 times more common in patients after a bout of diverticulitis than in controls. To date there are no data as to whether IBS occurs following an episode of CI. Methods: We reviewed the charts of all patients who underwent colonoscopy at Montefiore Medical Center from 1/2021 and 3/2022 and Yale New Haven Medical Center from 5/2021 and 3/2022. Inclusion determinants were (1) clinical presentation consistent with CI; (2) colonoscopic findings suggestive of CI; and (3) colonic pathology consistent with CI. Patients without all 3 inclusion determinants were excluded. Patients with intestinal surgery after CI, death prior to survey, previously diagnosed IBS, or an underlying GI disorder to explain symptoms also were excluded. All patients were contacted within 3-6 months of their index diagnosis of CI to answer a 4-question survey based on the Rome IV Criteria for IBS. The primary outcome of our study was the frequency of IBS after an episode of CI. Secondary outcomes were whether antibiotic usage, gender, or affected segment of colon correlated with the development of post-CI IBS. (Figure) Results: 65 patients with biopsy-proven CI were identified. 12 patients were excluded because they died or required surgery, 5 were unable to be reached, 1 declined to complete the survey, and 1 had IBS prior to CI. 46 patients were evaluated and completed the survey, of whom 13 (28.3%) developed post-CI IBS. Patients who received antibiotics were significantly more likely to develop post-CI IBS (p=0.02): 84.6% of patients with post-CI IBS received antibiotics, compared with 45.5% of patients who did not develop post-CI IBS. The segment of affected colon did not correlate with development of post-CI IBS (p=0.66). There was a trend for woman to develop post-CI IBS more frequently than men (84.6% vs 60.6%; p=0.16). (Table) Conclusion: Based on our study, post-CI IBS is likely a real entity, which has not been previously described. Our study indicates that antibiotics may play a role in its development and that consideration should be taken prior to initiating antibiotics in patients with mild-to-moderate CI. Larger studies are needed to validate our findings.Figure 1.: Post-CI IBS Flow Diagram Table 1. - Predictors of Post-CI IBS Post-CI IBS No Post-CI IBS p value Post-CI IBS vs. No Post-CI IBS n (%) 13 (28.3%) 33 (71.7%) - Age (yrs) 63.3 67.0 0.41 Gender, n (%) Female Male 11 (84.6)13 (15.4) 20 (60.6)13 (39.4) 0.16 Antibiotics, n (%) Yes No 11 (84.6)13 (15.4) 15 (45.5)18 (54.5) 0.02 Location of Disease, n (%) IRCI Left-sided or pancolitis 1 (7.6)12 (92.4) 5 (15.2)28 (84.8) 0.66