Exercise-Induced Colon Ischemia in a Middle-Aged Female Athlete: Response to a Novel Therapeutic Approach of Sildenafil and Fludrocortisone.
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2025-10
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Abstract
Colon ischemia is the most frequent form of intestinal ischemia. It is likely most commonly caused by mesenteric vasoconstriction in the microvasculature, though such vasoconstriction has never been documented, considering colonic blood flow has already normalized by the time of presentation. Long-distance running is a rare cause, presumably from blood shunting away from splanchnic vasculature. No effective treatment has previously been reported. We present a 41-year-old woman with recurrent abdominal pain and hematochezia after exercise. Initial workup was unrevealing, prompting a clinical diagnosis of exercise-induced colon ischemia from transient, reversible mesenteric vasoconstriction. Treatment with the vasodilator sildenafil and fludrocortisone for blood pressure support resulted in symptom resolution and her ability to return to exercise without adverse gastrointestinal symptoms.
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Gadi, Sanjay RV, Lawrence J Brandt and Jatin Roper (2025). Exercise-Induced Colon Ischemia in a Middle-Aged Female Athlete: Response to a Novel Therapeutic Approach of Sildenafil and Fludrocortisone. ACG case reports journal, 12(10). p. e01864. 10.14309/crj.0000000000001864 Retrieved from https://hdl.handle.net/10161/33612.
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Scholars@Duke
Sanjay Gadi
Jatin Roper
My laboratory is interested in understanding the molecular mechanisms of stem cell function in the normal intestine and in colorectal cancer using innovative three-dimensional organoid and in vivo platforms. We demonstrated that high fat diet-induced obesity activates peroxisome proliferator-activated receptor delta (PPARd) signaling in intestinal stem cells and progenitor cells, which increases stem cell regeneration and tumor initiation in the colon. We also pioneered novel orthotopic transplantation and in situ CRISPR/Cas9 gene editing models of colorectal cancer that recapitulate the adenoma-carcinoma-metastasis sequence. Research in the laboratory is focused on three main areas: 1) Immune regulation of the intestinal epithelium and colorectal cancer; 2) The effects of diet-induced obesity on regeneration in the intestine; and 3) analysis of colorectal cancer heterogeneity with single-cell mRNA sequencing and genetically engineered mouse models. The overall goal of this research is to develop new treatment approaches for intestinal diseases such as inflammatory bowel disease and colorectal cancer. I am also a gastroenterologist at Duke University Hospital and the Durham VA Hospital. My clinical interests include colorectal cancer screening and gastrointestinal cancer genetics.
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