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Clogged arteries in the gut?

Known as intestinal angina, this rare but serious condition causes severe belly pain after eating.

Cholesterol-filled plaque and clots can lurk in blood vessels throughout the body. While the arteries that supply the heart are by far the most common hiding place, arteries elsewhere in the body can also become severely narrowed by plaque.

Clogged vessels in the legs (and less commonly, the arms) can lead to limb pain during exercise, because the nearby muscles don’t get enough blood to work properly. People with this problem—called peripheral artery disease, or PAD—are also at risk for narrowing in the arteries that feed the intestines.

Upper belly pain

These narrowed vessels cause intestinal angina, a condition that is more common in women, especially those who are current or former smokers. The classic symptom is pain in the upper abdomen, just above the navel, that occurs about 30 minutes after eating a regular meal, says Dr. Michael Belkin, professor of surgery at Harvard Medical School. “It’s very reproducible pain in that it happens every time you eat, not just some of the time,” he explains. People often describe the pain as an aching sensation that lasts from one to two hours. Other possible symptoms include diarrhea, nausea, and vomiting.

Several more common gastrointestinal problems, such as gallstones, ulcers, and pancreatitis, can also cause upper abdominal pain. As a result, getting a correct diagnosis sometimes takes months. By the time people see Dr. Belkin, many of them have already undergone several tests to rule out those more common conditions. But a history of smoking and weight loss are often key clues, he notes.

Intestinal Angina

intestinal-angina

Your digestive system ordinarily gets about 20% to 25% of the blood pumped out by your heart. After you eat, blood flow to the stomach and intestines almost doubles.

But if plaque causes severe narrowing in two of three of the major arteries supplying the gut (the celiac artery, the superior mesenteric artery, or the inferior mesenteric artery), that extra blood can’t reach the intestines when they’re working to digest food.

Food fear and weight loss

Intestinal angina symptoms are so unpleasant that people with this condition are often afraid to eat. “They have what we call ‘food fear,’ and will often just eat tea and toast,” says Dr. Belkin. So they often lose quite a bit of weight—as much as 20 to 30 pounds, in some cases.

Such dramatic weight loss often raises the suspicion of cancer, which may lead to a computed tomography (CT) scan of the abdomen. If this test includes an injection of contrast dye, it may reveal the narrowed or blocked arteries.

People usually don’t develop symptoms unless at least two of three arteries to the bowel are involved. A diagnosis of intestinal angina usually involves the superior mesenteric artery and the celiac artery, says Dr. Belkin (see illustration).

Treating the problem

Treating this condition means restoring blood flow to the intestines. In most cases, doctors thread a catheter through a vessel to the blockage and insert a tiny metal mesh tube (stent) to prop open the artery, much as is done for narrowed coronary arteries. Compared with surgery, this approach is less invasive and usually a better option for older people, who often have other health complications that make surgery risky.

But just like stented coronary arteries, intestinal arteries are prone to re-narrowing, which is why people need to be followed closely in case their symptoms return. Some people with more advanced disease need surgery, which may end up being more durable in the long run.

The acute form

In rare cases, a blood clot may completely block an intestinal artery, causing intense abdominal pain that can last for several hours. This acute form of the condition—which can occur even in people without the relatively more common chronic form—requires emergency surgery. Without immediate treatment, the tissue downstream from the blockage begins to die, which can permanently damage the intestines.

Of all the vascular problems he treats, intestinal angina seems to cause his patients the most suffering, says Dr. Belkin. “They’ll say, ‘Please, just do whatever it takes to fix it. I can’t live like this.'”

Posted by: Dr.Health

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