In­testi­nal angina can be re­lieved

Daily Freeman (Kingston, NY) - - YOUR DAILY BREAK - An­thony Ko­maroff AskDr.K

For months I’ve ex­pe­ri­enced se­vere pain in my ab­domen af­ter eat­ing. Af­ter ex­clud­ing a num­ber of other con­di­tions, my doc­tor di­ag­nosed in­testi­nal angina. I’ve heard of angina re­lated to the heart — is this the same?

The un­der­ly­ing process is the same for in­testi­nal and car­diac angina. Let me ex­plain.

Choles­terol-filled plaque and clots can lurk in blood ves­sels through­out the body. The ar­ter­ies that sup­ply the heart are by far the most com­mon hid­ing place. But ar­ter­ies else­where in the body can also be­come se­verely nar­rowed by plaque.

Clogged ves­sels in the legs or arms can lead to limb pain dur­ing ex­er­cise, be­cause the nearby mus­cles don’t get enough blood to work prop­erly. This is called pe­riph­eral artery dis­ease, or PAD. Peo­ple with PAD are also at risk for nar­row­ing in the ar­ter­ies that feed the in­testines.

Your di­ges­tive sys­tem or­di­nar­ily gets about 20 to 25 per­cent of the blood pumped out by your heart. Af­ter you eat, blood flow to the stom­ach and in­testines al­most dou­bles. But if plaque causes se­vere nar­row­ing, not enough of that ex­tra blood reaches the in­testines when they’re work­ing to di­gest food. Peo­ple usu­ally don’t de­velop symp­toms un­less at least two of the three ma­jor ar­ter­ies to the bowel are in­volved.

These nar­rowed ves­sels cause in­testi­nal angina. The clas­sic symp­tom is pain in the ab­domen, just above the navel, that oc­curs about 30 min­utes af­ter eat­ing. This pain hap­pens every time you eat, not just some of the time. Peo­ple of­ten de­scribe the pain as an aching sen­sa­tion that lasts from one to two hours. Other pos­si­ble symp­toms in­clude di­ar­rhea, nau­sea and vom­it­ing. In­testi­nal angina symp­toms are so un­pleas­ant that peo­ple with this con­di­tion are of­ten afraid to eat.

Treat­ing in­testi­nal angina means restor­ing blood flow to the in­testines. In most cases, doc­tors thread a catheter (a thin plas­tic tube) through sev­eral ar­ter­ies un­til the tip of the catheter is at the site of the block­age. Then they insert a tiny metal mesh tube (stent) to prop open the artery. (This is very sim­i­lar to the pro­ce­dure per­formed to treat nar­rowed coro­nary ar­ter­ies.) But just like stented coro­nary ar­ter­ies, in­testi­nal ar­ter­ies are prone to re-nar­row­ing. Some peo­ple with more ad­vanced dis­ease need surgery.

In rare cases, a blood clot may com­pletely block an in­testi­nal artery. This causes in­tense ab­dom­i­nal pain that can last for sev­eral hours. A com­plete block­age re­quires emer­gency surgery. Oth­er­wise, the part of the in­tes­tine that is down­stream from the block­age be­gins to die. If it is not promptly cor­rected, the con­di­tion is of­ten fa­tal. The par­al­lels to angina of the heart and a full heart at­tack are clear.

A doc­tor col­league of mine be­gan to ex­pe­ri­ence ab­dom­i­nal pain fol­low­ing every meal. At first he thought it was heart­burn. But he be­gan to won­der if it was in­testi­nal angina. Then one night he was awak­ened by more se­vere pain in the same part of his ab­domen. He hadn’t eaten in seven hours. For­tu­nately, he re­al­ized what was hap­pen­ing, went to the emer­gency room and then promptly to surgery. They re­moved a part of his in­tes­tine that had died and saved his life.

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