Intestinal angina is very rare condition and its actual incidence is not known. However estimates suggest that females are about three times more prone to develop intestinal angina compared to males. The mortality rates associated with acute abdominal ischemia is also as high as 60 to 95%. The condition often affects elderly patients above the age of 60 years.
Abdominal or intestinal angina is a condition which is characterized by pain due to occlusion of the mesenteric vascular system, which results in inadequate supply of blood to meet the intestinal demand. The condition is often aggravated post lunch and has a mechanism which is very similar to angina pectoris.The causative factors responsible for this condition can be fairly similar to those responsible for coronary artery disease.
What Is Intestinal Angina?
Intestinal ischemia is attributed to mismatch in the oxygen supply and its consumption by the gastro-intestinal system. This is primarily due to inadequate supply of blood to the gastrointestinal system either due to occlusion by an emboli or a thrombus or due to narrowing of the mesenteric blood vessels due to atherosclerosis.
Three major arteries supply to the gastrointestinal system which includes the superior mesenteric, inferior mesenteric and the celiac artery. These arteries are interconnected by an efficient collateral blood circulation system and hence intestinal angina may occur only if there is an occlusion or severe stenosis of at least two of the three arteries.
The symptoms associated with intestinal angina manifest about fifteen minutes after lunch or a heavy meal, primarily as the blood demand of the gastro-intestinal system increases at this juncture.
Symptoms Of Intestinal Angina
The most important symptom associated with intestinal angina is increase in central abdominal pain about ten to fifteen minutes after eating. The pain may increases in intensity following a heavy meal and then drops gradually after several hours of eating.
Though during the early stage of the disease, the symptoms are associated with heavy meals, subsequently even small meals are associated with abdominal pain. The pain is poorly localized and very debilitating. In addition to this symptom there are other symptoms associated with the condition,
- Motility disturbances may be observed and the patient may complain of constipation or diarrhea along with vomiting and abdominal bloating.
- Sudden weight loss is another symptom which is associated with the condition.
- The patient may have a history of diabetes and coronary artery disease which is indicative of a possibility of intestinal angina.
In addition to the symptoms, there are certain signs that are useful in making the diagnosis for the condition. The abdomen is scaphoid and soft and abdominal bruit is present in almost 80% of the patients. In addition other signs of peripheral vascular disease like calf claudications, coronary artery disease, etc may also be present.
Treatment For Intestinal Ischemia
Unfortunately there is no medical treatment available for the management of this condition. Angioplasty may be beneficial in a select group of patients, depending upon the history and the extent of occlusion.
Surgical intervention is inevitable and is essential for life saving purposes. There are two surgical treatment options available which include open surgery and endovascular surgery. The selection of the surgical technique would depend upon a host of factors including the patient’s condition and health status.
There is no specific dietary consideration for the management of this condition. However a well balanced diet is crucial, especially since these individuals are cachectic and a healthy diet would hasten recovery.