Not just a stomachache: What is chronic mesenteric ischemia?

By  | 

Chronic mesenteric ischemia causes severe stomach pain and is often overlooked or misdiagnosed. It affects fewer than 200,000 people a year in the U.S., and vascular surgeons can now treat the condition with a procedure that means a faster recovery.

Angela Kulacki and her fiance, Jim, had been searching for answers for Angela’s chronic stomach pain. For almost 10 years, she’d eat, then double over.

“People would tell me I was very pale," Angela recalled. "‘What’s the matter with you, you’re losing so much weight? You look terrible.'”

Angela suspected an ulcer. Her doctor thought gallbladder.

“After they took my gallbladder out, I still had the same pain,” Angela said.

Finally, Angela was referred to vascular surgeon Dr. Paul Lucas.

An ultrasound of the abdominal wall showed plaque was clogging the major arteries leading to Angela’s small intestines, blocking blood flow. It’s called chronic mesenteric ischemia.

“Never heard of it, ever in my life,” Angela said.

The condition causes weight loss, pain after eating and fear of food.

“If left untreated, it can lead to a condition called acute mesenteric ischemia, which can be a life-threatening emergency,” Lucas said.

Now, doctors can treat the condition by implanting a small stent and using balloon angioplasty to open the blocked vessel, avoiding invasive open surgery.

Angela’s stomach pain disappeared just a few days after the procedure. Four months later, she’s feeling better than ever.

Angela says she has regained most of the 12 pounds she lost in the past year when the condition was most acute. Lucas says patients with stomach pain and risk factors like high cholesterol, diabetes or smoking should mention the condition to their physician so they can be evaluated.

MEDICAL BREAKTHROUGHS
RESEARCH SUMMARY
TOPIC: CHRONIC MESENTERIC ISCHEMIA: NOT JUST A STOMACH ACHE
REPORT: MB #4538

BACKGROUND: Chronic mesenteric ischemia is a rare condition, generally characterized by abdominal pain after eating. Although chronic mesenteric ischemia accounts for only a small percentage of all mesenteric ischemic events, it can have significant clinical consequences. The diagnosis is usually late in its course due to the slow progression of disease and the abundance of mesenteric collaterals. Because of the extensive collateral network, usually at least two of the three visceral vessels need to be affected before patients develop symptoms. Once a diagnosis of chronic mesenteric ischemia is made, treatment options include open surgical revascularization and endovascular revascularization.
(Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036470/)

DIAGNOSING: The National Center for Biotechnology Information says classic symptoms of chronic mesenteric ischemia include postprandial abdominal pain associated with significant weight loss, food fear, nausea, vomiting, or diarrhea. The abdominal pain classically starts 15 to 30 minutes after a meal and typically lasts for 30 minutes. As the obstructive process progresses, chronic, dull abdominal pain ensues. Chronic mesenteric ischemia generally presents in patients older than 60 years of age and is three times more frequent in women.
(Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036470/)

NEW TECHNOLOGY: Paul Lucas, MD, FACS, RPVI, a vascular surgeon at Mercy Medical Center in Baltimore talked about the past and present treatments: “The traditional treatment was an open abdominal surgery, with a bypass of those stenotic ordinary vessels. More recently, there is minimally invasive approaches that we tend to use more often now, which would involve an angiogram just placing a catheter in the artery using an IV contrast and dye, then we can treat it with balloon angioplasty and stents.” In terms of recovery, Dr. Lucas says patients can return to their normal diet as long as they can tolerate it. “The recovery from the procedure itself is related to the arterial access. There may be some discomfort in the access site in either the groin or the wrist for several days. Once that settles down usually people do pretty well. The abdominal pain in and of itself can take several days to a couple of weeks to resolve. But usually people will feel some relief very quickly.”
(Source: Paul Lucas, MD, FACS, RPVI)