Chronic gastrointestinal ischaemia: shifting paradigms

Abstract

Chronic gastrointestinal ischaemia (CGI) is generally considered to be a rare disease entity. The majority of patients with CGI are only diagnosed after a long period of slowly progressive abdominal symptoms, in some cases with impressive weight loss. These patients may have a broad range of clinical signs and quite often undergo repeated extensive evaluation of their symptoms with negative outcome. The classical triad of symptoms, also known as 'abdominal angina', is defined as the combination of postprandial pain, weight loss due to fear of pain after eating, and an abdominal bruit during physical examination. Recent studies have shed new lights on these long unchallenged concepts. These studies first showed that CGI is more prevalent than previously thought and can occur in patients with both single- and multi-vessel disease. Second, the disease presents with a much wider range in symptoms, and only a minority of patients present with the classical triad. Third, long-term positive outcomes can be achieved after endovascular or surgical revascularisation therapy in large proportion of patients. This knowledge results from a combination of clinical research by dedicated focus groups, the current widespread availability of new imaging techniques such as CT-angiography, the development of new functional tests for assessment of mucosal perfusion, and the evolution of endovascular stenting options. Clinicians diagnosing and treating patients with acute and chronic abdominal conditions have to be aware of these new developments. We therefore here review the new insights on CGI with a focus on epidemiology, pathophysiology, current diagnostics and treatment.

Right colectomy with simultaneous vascular reconstruction for celiac and superior mesenteric arterial occlusion

“…The presented symptoms are indeed both attributable to intestinal obstruction and mesenteric ischemia. 6,7 Therefore, the radiological diagnosis of obstructing colon cancer could have masked the presence of coexisted mesenteric ischemia in this patient.…”

“…CT angiography is considered useful for assessment of the patency of gastrointestinal arteries with visualization of surrounding structures. 6 Thus, a standard, preoperative staging CT does not seem to be sufficient to detect vascular abnormalities. CT angiography is advantageous in precise assessment of gastrointestinal vasculature, but it is questionable for its routine use in patients undergoing oncologic abdominal surgery.…”

Lesions of the gastric mucosa in adult horses of different disciplines: a review

“…Siebzehn Pferde hatten Läsionen in der PNGl mit einem mittleren Score von 1.05±0,98 (Scoring System 0 -6 nach Nieto et al 2002). Bei 8 Pferden wurden Läsionen in der PGl festgestellt, für welche die Autoren keinen mittleren Score angegeben, sondern sie als "aktiv" blutend beschreiben (Nieto et al 2004 (Gil et al 1998, Mensink et al 2011, Wright et al 2011. Das Blut aus dem gastrointestinalen Bereich wird rasch im Körper umverteilt und steht für die Versorgung anderer Organe wie Herz, Lunge, Muskulatur und Haut zur Verfügung (Qamar und Read 1987, Otte et al 2001.…”

The Use of Bitter Herbs in Practice

“…The intestinal phase is characterized by an increased blood flow in the superior mesenteric artery [8] and can last for more than four hours [10]. Blood flow may increase from 800 to 1000mL/minute in the celiac artery during the gastric phase and from 500 to 1400mL/minute in the superior mesenteric artery during the intestinal phase [11].…”