The Clinical Impact of Tonometry on the Diagnosis and Treatment of Gastrointestinal Ischemia

This thesis focuses on two issues: 1) the clinical value of gastric exercise tonometry (GET), and 2) the development of reliable prolonged tonometry, including postprandial measurement, and its potential in patients suspected of gastrointestinal ischemia. Including GET in the analysis of patients with solitary celiac artery stenosis had major clinical impact. The GET results enabled us to distinguish between patients with and without gastric ischemia. The clinical improvement after vascular treatment in ischemic patients was sustained for up to 4 years, and compares favorably to earlier reports. These results put the single vessel splanchnic syndrome on the map as a clinical entity. The ability of GET to separate ischemic form non-ischemic patients proved beneficial in the large cohort of patients with both single-and multi-vessel splanchnic stenoses as well. Similar to the single-vessel patients, GET identified patients with gastrointestinal ischemia, subsequent treatment resulted in good results on mid-term follow-up. The single-and multi-vessel patients differed significantly in patient characteristics, clinical presentation, morbidity and mortality (before and after treatment). This leads to the notion that the chronic splanchnic syndrome (CSS) has to be divided into two different entities, with different diagnostic and therapeutic approach, urgency, and goals of treatment. Prolonged tonometry, including postprandial measurements, proved feasible in healthy subjects when in vitro tested standard meals were taken and high dose acid suppression was administered. From this study ‘normal’ values were obtained. Using these normal values in a cohort of patients, the accuracy for ischemia detection of prolonged tonometry showed acceptable results. Careful and prospective studies are clearly needed to confirm these first results before prolonged tonometry can be advocated in patients suspected for CSS.

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