Abdominal pain that occurs half an hour after eating a heavy meal may indicate chronic gastrointestinal ischemia. This condition is also called abdominal angina.
Chronic ischemia of the gastrointestinal tract can be caused by partial obstruction of the mesenteric vessels that are in the intestine and are responsible for its blood supply.
The cause of the disease is usually atherosclerotic plaque, which limits (significantly narrows or completely closes) the lumen of the artery, i.e. its internal cross-section. The blood does not reach the intestines in sufficient quantity, so the intestines do not receive the oxygen they need in more amounts when digestion begins. That is why there is severe pain after a meal.
Atherosclerotic plaque is primarily made of cholesterol. But it also contains fatty compounds, proteins, calcium salts and an overgrown vessel muscle. The growth of the atherosclerotic plaque causes hardening of the artery, and when it becomes thickened and stiff, it is impossible for blood to flow freely through it.
As already mentioned, the clearest symptom of the disease is abdominal pain, which occurs around the navel, usually half an hour after eating a meal. The pain is more severe the more difficult the meal is to digest. It is also characteristic that the pain returns after each meal, which is related to the digestion and absorption of nutrients in the body. In the course of these processes, the intestines are more active, so they need more blood for all processes to function properly.
The presence of fatty diarrhea is also typical for abdominal angina (the stool is shiny, has a very unpleasant putrid smell, it is difficult to rinse it from the shell).
Another symptom of the disease is rapid weight loss. This is for two reasons. The first is knowingly restricting food, which causes severe abdominal pain. The second is the malabsorption of nutrients.
Risk of getting sick
The greatest risk of developing abdominal angina occurs in people who are heavy smokers, diabetics, people who are severely overweight and obese, suffer from hypertension, and people with hypercholesterolemia, i.e. high blood cholesterol levels.
Diagnosis of the disease
It is not always easy, because similar symptoms occur in diseases of the pancreas, especially in people who abuse alcohol. In addition, abdominal pain is sometimes treated as a symptom of coronary diseases.
The diagnosis can be confirmed by performing duplex ultrasound of the visceral arteries. More often, however, arterography is ordered to determine the location and extent of atherosclerotic lesions in the abdominal arteries.
Treatment of abdominal angina
The therapy begins with conservative treatment, which consists in taking anticoagulants. Typically, patients are given drugs from the group of nitrates, pentoxifylline or acetylsalicylic acid. However, it should be remembered that these are drugs that only alleviate the course of the disease, but do not cure it. In advanced cases of the disease, angioplasty is performed. The indication for the procedure is acute intestinal ischemia caused by embolism or spasm of the mesenteric artery, thrombosis of the mesenteric artery or vein. The same is true for chronic intestinal ischemia. The operations are to restore proper blood flow through the changed vessels.
In the case of chronic intestinal ischemia, percutaneous intravascular procedures – angioplasty or stent implantation – are often performed. In most patients, these treatments are effective and have a low risk of complications. If the patient complies with postoperative recommendations, angioplasty ends his problems. However, constant health monitoring is necessary.
Acute intestinal ischemia can also be treated with percutaneous ballooning and stenting. Sometimes it is necessary to surgically remove a fragment of the intestine that has been damaged by severe ischemia.
Abdominal angina is a disease that can effectively make our lives unpleasant, causing problems with eating. But it is also a condition that can be life-threatening.
The average age of patients with acute intestinal ischemia due to obstruction of the visceral arteries is 70 years. Most (2/3) of the sick are women.
Most patients with chronic intestinal ischemia have cardiovascular disease. In 30-50% of cases, treatments are performed due to atherosclerosis. Usually these are procedures involving the implantation of aorto-coronary bypass. Women account for 70 percent. patients with chronic intestinal ischemia.
The basic symptom of abdominal (visceral) angina, i.e. acute abdominal pain that occurs shortly after eating a meal, is easy to remember. If such complaints occur, see a doctor quickly.
Tekst: Anna Jarosz