This medical condition occurs when blood flow to your small intestine is restricted by blocked or narrowed blood vessels.
It is more common in smokers, and in people older than age 60, especially females.
There are two types:
Acute mesenteric ischemia (AMI) is a constant and severe decrease in blood flow. A blood clot (a clump of blood which has changed from a liquid to a gel-like state) which forms in the heart and then breaks free and blocks the mesenteric arteries often causes AMI. AMI affects approximately 5 per 100,000 people per year.
Chronic mesenteric ischemia (CMI) – it is a rare condition which was first described in 1918 as “abdominal angina” by Goodman. It affects approximately 1 per 100,000 people per year.
Common symptoms of AMI include:
- sudden, severe stomach pain.
Common symptoms of CMI include:
- severe abdominal pains 15 to 60 minutes after eating;
- severe diarrhea;
AMI is generally caused by a blood clot, that travels to one of the mesenteric arteries (they take blood from the aorta) and blocks blood flow. Also, over 90 percent of sufferers will have an abnormally elevated leukocyte count.
CMI commonly results from long-standing atherosclerotic disease of 2 or more mesenteric vessels.
In atherosclerosis (also known as hardening of the arteries), calcium and fatty deposits can build up along the inner artery walls and form plaque. Over time, this may cause the arteries to narrow.
The primary complications of CMI are bowel infarction with malabsorption or necrosis. In addition, many sufferers will have a cardiovascular disease that will require medical management.
Risk factors include:
- use of cocaine;
- older age;
- recent heart attack;
- low blood pressure;
- decompression sickness, also known as divers’ disease, a deep water diving injury;
- kidney failure;
- high blood pressure;
- vasculitis (an inflammation of the blood vessels);
- diverticulitis (inflammation or infection of small pouches);
- pancreatitis (inflammation in the pancreas);
- blood which easily clots;
- cigarette smoke;
- high triglycerides in the blood;
- high LDL and total cholesterol;
- atrial fibrillation;
- heart valve disease;
- heart failure;
- coronary artery disease.
Early diagnosis of this medical condition is especially vital because mortality increases notably once intestinal infarction has occurred. Diagnosis options include:
- Angiogram – performing an angiogram can help to identify and treat underlying blockages which may cause the condition.
- CT Scan – it allows for an accurate diagnosis of atherosclerosis.
- Ultrasound – it may be able to detect the condition and can be performed in the office.
The goal of treatment for the condition is to re-open the artery to allow a healthy blood flow to reach the intestine. Treatment option includes:
- long-term anticoagulation;
- angiographic – thrombolysis or vasodilators;
- surgical – embolectomy.
Ischemic Colitis (IC)
It occurs when blood flow to part of the large intestine is reduced, typically due to narrowed or blocked blood vessels. The condition can be nongangrenous or gangrenous.
The rate of IC nearly quadrupled in the last 3 decades, according to a 2015 population-based study that was issued in the journal Clinical Gastroenterology and Hepatology.
The condition is more frequent in people over age 60, however, younger folks can get it too.
Common symptoms of IC can include:
- a feeling of urgency to move your bowels;
- red or maroon-colored blood in the stool;
- cramping or tenderness in the belly.
The condition occurs when there’s a lack of blood flow to your large intestine. This deprivation of oxygen is generally due to narrowed or blocked arteries.
You have a higher risk of developing ischemic colitis if you:
- take medications to treat migraines and for hormone replacement therapy;
- have a history of surgical procedures to the aorta (the main artery in the human body);
- have low blood pressure;
- have diabetes;
- have congestive heart failure.
Healthcare professionals may ask for any of the following tests to help determine if you have IC:
- Colonoscopy – it is an exam that is used to detect changes in the colon. Also, the healthcare provider may take tissue samples to confirm a diagnosis.
- Stool samples – the healthcare provider looks for infections which may be behind your symptoms.
- Imaging tests – it uses X-rays at different angles to get a detailed image of the blood vessels and large intestine.
Common treatment options include:
- avoiding medicines which constrict the blood vessels;
- treatment for congestive heart failure or an irregular heartbeat;
- intravenous fluids;
- surgery, only if your symptoms are severe or the large intestine has been damaged.
Bottom Line – Mesenteric Ischemia vs Ischemic Colitis
Mesenteric ischemia is a condition that is characterized by obstruction of one of the arteries to the intestines. Symptoms include:
- rapid heartbeat;
- intermittent dull or cramping pain beginning 15 to 30 min after a meal;
- bloody stools;
- severe, cramping abdominal pain;
- rectal bleeding;
- diarrhea or constipation;
- change in eating habits due to post-meal pain;
- abdominal swelling;
- weight loss;
Ischemic colitis is an inflammatory condition of the large intestine. Most patients have a previous history of atherosclerotic disease. Symptoms include:
- reoccurring need for a bowel movement;
- abdominal pain or cramping;
- blood in the stool;
- passage of blood.
References https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3482654/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4442720/ https://www.ncbi.nlm.nih.gov/pubmed/22811227