Gastric exercise tonometry: The key investigation in patients with suspected celiac artery compression syndrome

Abstract

The results of this study suggest that the celiac axis compression syndrome exists and that the actual ischemia can be detected by gastric exercise tonometry and treated safely, with success.

Diagnosis and management of splanchnic ischemia

“…We have used GET to guide treatment in patients with single vessel stenoses. The main finding in this study was the tight relationship between normalization of GET and disappearance of symptoms after anatomically successful revascularization [5] . We also re-examined the potential use of a 24-h tonometry test, including test meals, with standardization of the test circumstances, including potent acid suppression and standard test meals [85] .…”

“…These opinions were challenged recently by our group. We have shown that by using tonometry as a functional test, we could successfully distinguish patients that benefited from surgery from those who did not, and that the disappearance of symptoms after successful revascularization was associated with normalization of this functional test [5] . The prognosis of single-vessel CSS seems rather benign.…”

“…The etiology of isolated stenoses of the splanchnic arteries, most often the celiac artery, is caused in most cases by splanchnic arteriosclerosis or external compression by the crux of the diaphragm [5] . Due to the presence of abundant collateral vessels, it was generally assumed that a single stenotic lesion rarely, if ever, causes complaints [43] .…”

“…Different techniques are currently used to release the CA from compression by the diaphragm's crux. One potential complication is the development of reflux disease [5] , which is related to the damage to the crux, which also plays an important role in the physiological anti-reflux barrier. Recently, we have performed the release by an endoscopic retroperitoneal technique with equally good results compared to the open approach in the short-term [103] .…”

“…Using an ischemia-specific test it should be possible (1) to identify patients with symptomatic vessel stenoses, or CSS, which can be treated, and (2) to make this diagnosis in time and thus prevent the disaster of acute intestinal infarction. Secondly, the increasing evidence that one vessel CSD may cause splanchnic ischemia resulting in one vessel CSS, and can be successfully treated with appropriate selection procedures [5] . An important difference in presentation, treatment and outcome has been shown to exist between single and multi-vessel disease [6] .…”