17 Mar Cocaine Use and Ischemic Colitis
Ischemic colitis is a gastrointestinal condition characterized by abnormally low blood flow to the large intestine, also known as the colon. The severity of the condition varies considerably and can produce results that range from mild abdominal pain to a potentially fatal situation called septic shock. Cocaine use can lead to changes in blood vessel health that support the onset of ischemic colitis. When compared to people who don’t use cocaine, users of the drug have increased risks for developing serious forms of the condition. They also die from ischemic colitis much more frequently than their non-cocaine-using counterparts.
Ischemic Colitis Basics
In order to perform its job properly, the large intestine requires large amounts of oxygen-rich blood. In fact, depending on the specific activities taking place within this organ at any given time, it receives anywhere from roughly 10 to 35 percent of all of the blood circulating from the heart to the body. The vessels that supply the required blood flow to the large intestine are known as the inferior and superior mesenteric arteries. When blood flow through these arteries drops to approximately 50 percent below normal, the tissues in the large intestine grow inflamed and start to develop varying degrees of structural damage. Doctors refer to the end result of this chain of events as ischemic colitis.
Potential causes of the blood flow drop that leads to ischemic colitis are abnormally low blood pressure within the mesenteric arteries, an unusual degree of narrowing (vasoconstriction) in the mesenteric arteries, and blockages in the mesenteric arteries caused by blood clots traveling from elsewhere within the circulatory system. The extent of damage produced by the condition typically varies according to the extent of blood flow loss. Relatively minor forms of ischemia-related damage include intestinal swelling and hemorrhaging (bursting) of the tiny blood vessels in the intestinal lining. More serious forms of potential damage include tissue death, ulcers in the intestinal lining, the formation of pus-filled lesions called abscesses, and perforations (holes) that go right through the intestinal wall. Severe infections resulting from an intestinal wall perforation can lead to the onset of a life-threatening form of low blood pressure called septic shock.
Cocaine’s Effects on the Blood Vessels
Among its many effects, cocaine increases the body’s levels of a neurotransmitting chemical called norepinephrine; along with another chemical, called epinephrine, norepinephrine is the main promoter of increased activity in a part of the nervous system called the sympathetic nervous system. Under everyday conditions, this system helps regulate the stable function of blood vessels throughout the body, as well as stable function of the heart, kidneys, lungs and several other organs. However, in the face of danger or extreme stress, this same system activates the body’s emergency “fight-or-flight” response. By artificially increasing norepinephrine levels, cocaine trips the fight-or-flight response and alters normal organ function. In the context of ischemic colitis, the main consequence of this alteration is blood vessel narrowing that significantly drops the amount of blood flowing through the mesenteric arteries.
Mechanisms of Cocaine-Related Ischemic Colitis
As we just noted, the main mechanism in cocaine-related ischemic colitis is abnormal narrowing of the inferior and superior mesenteric arteries. However, in some cases, cocaine users develop the disorder as a consequence of blood clots that migrate from elsewhere in the body and lodge in one of the two mesenteric arteries, or in the smaller blood vessels within the intestinal wall. In addition, the presence of cocaine in the bloodstream may also directly damage the intestinal lining.
A study published in 2012 in the journal Gastrointestinal Endoscopy examined the differing effects of ischemic colitis in cocaine users and people who don’t use cocaine. The authors of the study concluded that people with cocaine-related ischemic colitis develop the condition an average of 16 years earlier than their non-cocaine-using counterparts. Once hospitalized for their condition, cocaine users with ischemia require bowel surgery fully five times more frequently than people who don’t use cocaine. Cocaine users also have significantly higher risks for a condition called pneumatosis of the bowel wall, which involves an abnormal buildup of gas within the wall of the large intestine; people with this condition die from ischemic colitis at an unusually high rate. In line with this fact, cocaine users with ischemic colitis die from colitis-related complications almost six times as often as people who don’t use the drug.
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