ACG Clinical Guideline: Epidemiology, Risk Factors, Patterns of Presentation, Diagnosis, and Management of Colon Ischemia (CI)

Abstract

INTRODUCTION This clinical guideline was designed to address colon ischemia (CI) including its definition, epidemiology, risk factors, presentations, methods of diagnosis, and therapeutic interventions. Each section of the document will present key recommendations or summary statements followed by a comprehensive summary of supporting evidence. An overall summary of all recommendations is listed in Table 1.Table 1: Recommendations and summary statementsTable 1: Continued.A search of MEDLINE (1946 to present) and EMBASE (1980 to present) with language restriction to English was conducted using the search terms ischemic colitis, ischaemic colitis, colon ischemia, colonic ischemia, colon ischaemia, colonic ischaemia, colon gangrene, colonic gangrene, colon infarction, colonic infarction, rectal ischemia, rectal ischaemia, ischemic proctitis, ischaemic proctitis, cecal ischemia, cecal ischaemia, ischemic colon stricture, ischaemic colon stricture, ischemic colonic stricture, ischaemic colonic stricture, ischemic megacolon, ischaemic megacolon, colon cast, and colonic cast. The references obtained were reviewed and the best studies were included as evidence for guideline statements or in the absence of quality evidence, expert opinion was offered. The GRADE system (Grading of Recommendations Assessment, Development, and Evaluation) was used to evaluate the quality of evidence and strength of recommendations (1, 2). The level of evidence ranged from “high” (implying that further research was unlikely to change the authors’ confidence in the estimate of the effect) to “moderate” (further research would be likely to the authors’ confidence in the estimate of effect) to (further research would be to the authors’ confidence in the estimate of the and would be likely to change the to estimate of is The strength of a was as the of the and as was the the and of in clinical guideline with in the GRADE system is designed to the quality of the for of with that the a GRADE is the that to the colon is to a level to The of is that the of the ischemia is from the a of the that to ischemic ischemia be followed by for of ischemia, of The to colonic ischemia with the of the the of and the of the with or or and in the as the and for the is of gangrene, colitis, ischemic to is of The absence of a for ischemia in the of for This is used in the the of and of to ischemic as as and This in the be reviewed or be to to with the to ischemic a of is the in of all for or in of with of the of in the the was of of the was with of for or of of with a with in of all and with An of of of were is in in and of in that was and that and all were to be in from to and of and in studies for and were and in and and in with as in will be to the of with and with likely to from in the or from or in the the is to be and for ischemia is and to ischemia, likely a of as in the is and of or This for is used in clinical in with the is in a and An of of is with clinical of and in the including of and of the of the rectal with The colon is to ischemia, to its its in of and its to the of is statements and of in with clinical of and be in to is in with a of is and with from for be in with and in all with in the as and of in with clinical of a of and be and of evidence studies of risk for and and of The used in studies risk to that a risk of the of of studies be in of the in and in research Table the for the in of research methods and of of comprehensive of or and of from by as and studies and a the of the by risk to that or of including rectal and of and the of that of or or from all studies in as as and be in of in with a as likely is to that and with colon ischemia in of and risk for by the in and and were as in with ischemia with of that and in with a a of in of with or all of of the that be by and of in of and and were in with in with or with with or with colonic of and in from in and the in and with to the of and and to the risk of with including of with is risk in as a risk for used to with was from the of of the its in a of of the of was in with the risk for was and for with and for studies to the of as a risk for studies risk including that in and the risk in in the the in the that the of in of a the in of risk and as a of and the of be a clinical for was a risk in as with a to with as a risk for from as in absence of in its in was present in of from and was as in with as in that to the of and 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