Intestinal angina occurs when the visceral arteries are unable to provide sufficient blood flow to meet the increased metabolic demands of the postprandial state. For this to occur, it is generally necessary for there to be hemodynamically significant stenoses or occlusions of a t least two of the three major arteries which supply the gastrointestinal tract. Because this syndrome has no associated pathognomonic symptoms and signs, it can only be implicated by exclusion.' -Confirmation of the diagnosis requires contrast angiography. There is a need for a highly sensitive and specific noninvasive test for mesenteric arterial insufficiency.Ultrasonic duplex scanning provides anatomic information relating to arterial luminal narrowing and is also capable of providing quantitative information about blood flow velocity. The test has been highly successful in the noninvasive diagnosis of extracranial cerebrovascular disease,4 and in the localization of peripheral arterial s t e n~s i s .~ This report documents the use of this technique for the diagnosis of intestinal angina.
CASE REPORTA 54-year-old female presented with a 6-month history of postprandial epigastric pain and diarrhea. These symptoms caused involuntary curtailment of the size and frequency of meals, with a reported 30-pound weight loss. The patient had been taking conjugated estrogens for the treatment of menopausal symptoms. She noted that discontinuation of the drug slightly alleviated these symptoms. The postprandial pain was also relieved by sublingual nitroglycerin tablets, but