Diagnosis of Chronic Gastrointestinal Ischemia
(De diagnostiek van chronische gastrointestinale ischemie)
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Three aortic branches provide the arterial blood supply to the gastrointestinal tract: the celiac artery (CA), superior mesenteric artery (SMA) and inferior mesenteric artery (IMA). The CA supplies stomach, liver, part of the pancreas and proximal part of the duodenum. The SMA supplies the distal part of the duodenum, the entire small bowel and the proximal colon. The IMA is relatively small and supplies the distal colon. The anatomy of these arteries varies largely and gastrointestinal artery stenotic disease is not uncommon. Occlusive gastrointestinal arterial disease often remains asymptomatic, due to the presence of abundant collateral circulation. Only patients with significant arterial stenosis in combination with insufficient collateral circulation develop clinical signs of mesenteric ischemia. In these cases, the diagnosis is often missed due to lack of sensitive diagnostic tests. The diagnostic approach in patients with possible chronic gastrointestinal ischemia (CGI) focuses on identification of gastrointestinal arterial stenosis and demonstration of mucosal ischemia. This thesis deals with the diagnosis of chronic gastrointestinal ischemia, which often remains a clinical challenge. This in part explains why CGI was for long considered to be a very rare disease, only presenting in patients with multiple stenotic abdominal arterial disease. The existence of single vessel abdominal arterial disease has long been debated. We therefore firstly reviewed the existence and characteristics of single vessel abdominal arterial disease.
Financial support for printing this thesis was kindly given by the Department of Gastroenterology
and Hepatology of Erasmus MC-University Medical Center Rotterdam, Erasmus University
Rotterdam, Nederlandse Vereniging voor Gastroenterologie, J.E. Jurriaanse Stichting,
Janssen-Cilag B.V., Tramedico B.V., Norgine B.V., Zambon Nederland B.V., Ferring B.V., Abbott
Products B.V., Abbot Immunology B.V., Olympus Nederland B.V., AstraZeneca B.V., Dr. Falk
Pharma Benelux B.V..
- mucosal ischemia