Afib: Causes, Symptoms, and Treatment Options
What To Know About Mesenteric Ischemia
Mesenteric ischemia, or small bowel ischemia, involves a blockage of blood flow to the small intestine. Symptoms include pain and bloating. It often results from blood clots or atherosclerosis.
Mesenteric ischemia can appear suddenly (acute) or persist over time (chronic). Sudden or severe intestinal ischemia is a medical emergency.
Symptoms include abdominal pain and bloating soon after eating. Any case of mesenteric ischemia needs medical help. If it happens or worsens suddenly, it is a medical emergency.
Here, learn more about mesenteric ischemia, the different types, how to recognize it, and what to expect if it happens.
Small bowel or mesenteric ischemia occurs when the blood vessels leading toward or away from the small intestine become fully or partly blocked. This is often due to a blood clot, but it can happen for other reasons.
All types can involve abdominal pain and discomfort. Symptoms may range from mild to severe, but any case of mesenteric ischemia needs medical attention.
Without treatment, tissue death in the small intestine can lead to sepsis and other complications.
Acute mesenteric ischemia and mesenteric venous thrombosis are medical emergencies and need urgent attention.
The symptoms of chronic and acute small bowel ischemia can be similar. The main difference is that acute symptoms are sudden and severe, while chronic symptoms worsen over time.
A person with acute mesenteric ischemia may experience:
A person with chronic mesenteric ischemia may have:
Not all cases of acute mesenteric ischemia involve a total blockage.
Both acute and chronic mesenteric ischemia can result from:
In chronic ischemia, a person may live with reduced blood flow to the bowel for some time. Symptoms may worsen gradually, or the person may be under treatment to manage a known risk.
Around 40% to 50% of acute mesenteric ischemia cases are due to embolism, and 25% to 30% of cases are due to thrombosis.
Those most likely to experience acute mesenteric ischemia include:
A person has a higher risk of chronic mesenteric ischemia if they:
Treatment options will depend on the cause and whether mesenteric ischemia is acute or chronic.
For acute mesenteric ischemia, options can include:
Complications that can result from acute mesenteric ischemia include:
If a person has symptoms of sepsis, fever, or severe pain lasting 14 to 21 days or longer, a doctor will likely recommend surgery.
Mesenteric ischemia needs medical attention and can be a medical emergency.
A person needs medical help if they experience new pain, bloating, or blood in the stool.
They need emergency medical care if symptoms are sudden, severe, and occur with fever and other symptoms.
The outlook for mesenteric ischemia will depend on various factors, such as whether it is acute or chronic, the cause, and how soon a person receives medical care.
Acute mesenteric ischemia
Acute mesenteric ischemia has a high rate of fatality or ongoing health problems. Between 60% and 80% of people do not survive. Factors that increase the risk include:
Seeking help as soon as symptoms arise can improve the outlook.
Chronic mesenteric ischemia
Chronic mesenteric ischemia can affect a person's quality of life. They may find it hard to eat and become unwell with infections and other conditions that necessitate frequent medical treatment, including hospital admissions.
Mesenteric or small bowel ischemia is when the blood flow to the small intestine becomes reduced or blocked. It can be a medical emergency.
Possible causes include atherosclerosis, a hernia, a blood clot, scar tissue, and low blood pressure.
It is important for anyone experiencing severe or sudden intestinal symptoms to seek emergency medical help.
Mesenteric Artery Disease
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Patients whose symptoms are mild to moderate can often manage their disease by making lifestyle changes such as quitting smoking, getting regular exercise, and working with their doctors to take care of related conditions such as diabetes, high blood pressure, and high cholesterol. Doctors often use minimally invasive procedures such as balloon angioplasty and stenting to relieve the narrowing and improve blood supply to the kidney and intestines. In severe cases, an abdominal bypass operation may be necessary to improve the blood flow to the intestine. These treatment options are listed as follows:
Balloon angioplasty. During this procedure, your doctor places a tiny, soft plastic tube called a catheter into the artery, usually in the groin, and inject a dye that makes the blood vessels clearly visible on an x-ray image. Your doctor can also use a special catheter that has a small balloon at the end, which can be inflated and deflated. The deflated balloon catheter is inserted through an artery in the groin and guided to the narrowed segment of the artery. When the catheter reaches the blockage, the balloon is inflated to widen the narrowed artery.
Stenting. In some cases, it may be necessary to place a stent. A stent is a small tube that holds open the artery at the site of the blockage. The stent is collapsed around a balloon when it is placed on the tip of the catheter and inserted into the body. Once the catheter reaches the blockage, the doctor expands the stent by inflating the balloon. The stent is left permanently in the artery to provide a reinforced channel through which blood can flow. Some stents (drug-eluting stents) are coated with medication that helps prevent the formation of scar tissue.
Arterial bypass surgery. If mesenteric artery disease is very advanced, or if blockages develop in an artery that is difficult to reach with a catheter, arterial bypass surgery may be necessary to restore blood flow. In this treatment approach, doctors place a bypass graft made of synthetic material or a natural vein taken from another part of the body. During the procedure, the surgeon will make an incision to expose the diseased segment of the artery, and then attach one end of a bypass graft to a point above the blockage and the other end to a point below it. The blood supply is then diverted through the graft, around the blockage, to bypass the diseased section of the artery. The diseased artery is left in place.
Chronic Multisite Pain Linked To Higher Risk Of Cardiometabolic Multimorbidity
Chronic pain at multiple sites is associated with an increased risk of cardiometabolic multimorbidity (CMM), with the risk increasing as the number of pain sites increases, according to study results published in Regional Anesthesia & Pain Medicine.
While previous studies have found chronic pain to confer greater risk of single cardiometabolic diseases, the association between chronic pain and cardiometabolic multimorbidity is unclear.
In a prospective cohort study using data from the UK Biobank, researchers examined the relationship between chronic pain and the risk of CMM and evaluated whether different combinations of chronic pain sites had varied effects on incident CMM. Included in the study were 452,818 individuals aged 37 to 73 years without a history of CMM at baseline. Incident CMM was defined as the coexistence of at least 2 of 3 cardiometabolic diseases (type 2 diabetes, ischemic heart disease, and stroke), identified through hospital records.
Mean participant age was 56 years, 56.23% of participants were women, and 95.01% were White. At baseline, approximately three-quarters had BMI values less than 30, the majority (approximately 80%) consumed alcohol 1 or 2 times weekly or less, and nearly one-quarter had hypertension. Slightly more than half were never smokers and the remainder were current or previous smokers.
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Our findings indicated that increasing the amount of chronic pain sites further accelerated the development of CMM.
While 39.9% reported no chronic pain, 1.3% experienced chronic pain all over their bodies. Participants with multiple chronic pain sites were more likely to be younger, women, obese, smokers, and of lower socioeconomic status and education level, with a higher prevalence of hypertension. Over a 16-year follow-up (median, 13.8 years), 0.98% of participants developed CMM, 4.46% developed type 2 diabetes, 3.17% had ischemic heart disease, and 1.50% experienced a stroke. The risk of CMM increased with the number of chronic pain sites, with participants having 4 or more such sites showing an 82% higher risk of incident CMM (hazard ratio [HR], 1.82; 95% CI, 1.61-2.06) and those with pain all over the body showing a 59% higher risk (HR, 1.59; 95% CI, 1.30-1.93).
Similarly, increased numbers of chronic pain sites were associated with higher risks of type 2 diabetes, ischemic heart disease, and stroke — particularly for stomach/abdominal pain combined with other pain sites, including headache regions, facial pain, hip pain, and head pain. Among participants with only 1 pain site, those with pain in the stomach/abdominal region had the highest CMM risk (HR, 1.58; 95% CI, 1.40-1.77). Subgroup analyses confirmed the association between number of chronic pain sites and CMM risk across various demographic and lifestyle factors, with stronger associations observed in women (P for interaction = .04). Sensitivity analyses supported the robustness of these findings.
Limitations of this study include its observational design, which introduces unidentified or unmeasured residual confounding factors and may not capture the intricacies of the associations between chronic pain and other diseases. Additionally, detailed information on chronic pain (such as its severity) was not obtained. The investigators concluded, "Our findings indicated that increasing the amount of chronic pain sites further accelerated the development of CMM." They added, "From a public health perspective, identifying individuals with chronic pain in multiple sites could potentially be a valuable strategy for early detection and intervention, helping to pinpoint 'at-risk' individuals in the early stages of cardiometabolic health deterioration."
This article originally appeared on Clinical Pain Advisor
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