Does ‘intestinal angina’ exist? A critical study of obstructed visceral arteries

Croft, Rodney J.; Menon, G.; Marston, Adrian

doi:10.1002/bjs.1800680509

Cited by 80 publications

(42 citation statements)

References 10 publications

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“…Autopsy-based estimates of prevalent mesenteric disease range from 30% to 80%. [10][11][12][13] Angiographic case series have defined associations between symptomatic peripheral atherosclerosis and renal atherosclerosis with unsuspected mesenteric arterial lesions 14,15 ; however, population-based data are lacking.…”

Section: Arch Internmentioning

confidence: 99%

Clinical Course of Mesenteric Artery Stenosis in Elderly Americans

Wilson¹,

Mostafavi²,

Craven³

et al. 2006

Arch Intern Med

119

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Section: Arch Internmentioning

confidence: 99%

Clinical Course of Mesenteric Artery Stenosis in Elderly Americans

Wilson¹,

Mostafavi²,

Craven³

et al. 2006

Arch Intern Med

119

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“…Symptomatic chronic gastrointestinal ischaemia is rarely diagnosed1-4 despite a relatively high prevalence of significant splanchnic atherosclerosis in angiographic5 6and autopsy studies 78 This discrepancy is explained by the abundant collateral circulation of the gastrointestinal tract, preventing ischaemia if a single vessel has been occluded 1…”

mentioning

confidence: 99%

Increased gastric Pco ₂ during exercise is indicative of gastric ischaemia: a tonometric study

Kolkman

Groeneveld

Berg

et al. 1999

Gut

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Background-Diagnosis of gastric ischaemia is diYcult and angiography is an invasive procedure. Angiographic findings may not correlate with clinical importance. Aims-To investigate whether tonometric measurement of intragastric PCO 2 during exercise can be used to detect clinically important gastric ischaemia. Methods-Fourteen patients with unexplained abdominal pain or weight loss were studied. Splanchnic angiography served as the gold standard. Three patients were studied again after a revascularisation procedure. Gastric PCO 2 was measured from a nasogastric tonometer, with 10 minute dwell times, and after acid suppression. Gastric and capillary PCO 2 were measured before, during, and after submaximal exercise of 10 minutes duration. Results-Seven patients had normal angiograms; seven had more than 50% stenosis in the coeliac (n=7) or superior mesenteric artery (n=4). Normal subjects showed no changes in tonometry. In patients with stenoses, the median intragastric PCO 2 (PiCO 2 ) at rest was 5.2 kPa (range 4.8-11.2) and rose to 6.4 kPa (range 5.7-15.7) at peak exercise; the median intragastric blood PCO 2 gradient increased from 0.0 kPa (range −0.8 to 5.9) to 1.7 kPa (range 0.9 to 10.3; p<0.01). Only two subjects had abnormal tonometry at rest; all had supernormal values at peak exercise. The PCO 2 gradient correlated with clinical and gastroscopic severity; in patients reexamined after revascularisation (n=3), exercise tonometry returned to normal. Conclusion-Gastric tonometry during exercise is a promising non-invasive tool for diagnosing and grading gastrointestinal ischaemia and evaluating the results of revascularisation surgery for symptomatic gastric ischaemia.

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“…In 3% of postmortem examinations, a narrowing of the CA, mostly atherosclerotic, of more than 50% was found without prior abdominal complaints [4,5], In another series of 720 angiographies only 17 cases of CA stenosis or occlusion were found, out of whom only 2 had no other obvious reasons for complaints [6].…”

Section: Discussionmentioning

confidence: 99%

The Celiac Axis Compression Syndrome

Loffeld

Overtoom²,

Rauwerda³

1995

Digestion

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An ongoing debate in the literature discusses whether compression of the celiac axis (CA) and/or the superior mesenteric artery (SMA) by the arcuate ligament of the diaphragm may be responsible for a clinical syndrome. Five patients with postprandial epigastric pain and weight loss, with a loud systolic bruit in the epigastric region are described. In 4 cases, no other obvious explanation for the complaints was present except compression of the CA and SMA by the arcuate ligament of the diaphragm as shown on angiography. One patient had cholecystolithiasis. Two patients suffered from thrombosis in the CA with major stenosis of the SMA. In 3 cases, solitary stenosis of the CA was present. In 3 cases, important collateral circulation was seen, and 1 patient had possibly ischemic gastric ulcers indicating the ischemic nature of the complaints. Vascular reconstruction was done in 4 patients. One patient with a stenosis of less than 50% underwent cholecystectomy and was free of complaints thereafter. All other 4 patients were free of complaints after the operation. The CA compression syndrome should be considered in the differential diagnosis of patients with upper abdominal pain, weight loss and a loud systolic bruit in the epigastric region.

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Does ‘intestinal angina’ exist? A critical study of obstructed visceral arteries

Cited by 80 publications

References 10 publications

Clinical Course of Mesenteric Artery Stenosis in Elderly Americans

Clinical Course of Mesenteric Artery Stenosis in Elderly Americans

Increased gastric Pco ₂ during exercise is indicative of gastric ischaemia: a tonometric study

The Celiac Axis Compression Syndrome

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Does ‘intestinal angina’ exist? A critical study of obstructed visceral arteries

Cited by 80 publications

References 10 publications

Clinical Course of Mesenteric Artery Stenosis in Elderly Americans

Clinical Course of Mesenteric Artery Stenosis in Elderly Americans

Increased gastric Pco 2 during exercise is indicative of gastric ischaemia: a tonometric study

The Celiac Axis Compression Syndrome

Contact Info

Product

Resources

About

Increased gastric Pco ₂ during exercise is indicative of gastric ischaemia: a tonometric study