Mesenteric Angina

A clinical syndrome caused by insufficient blood flow to the intestines due to vascular insufficiency, leading to abdominal pain after meals.

• Commonly seen in the elderly population.

• Often associated with other forms of atherosclerotic disease.

• Most often due to atherosclerosis affecting the major mesenteric vessels, particularly the coeliac artery and superior mesenteric artery.

• Reduced blood flow cannot meet the increased demand during digestion, leading to ischaemia.

• Postprandial abdominal pain: Typically occurs within an hour of eating and can last for several hours.

• Weight loss: Due to avoidance of eating because of the pain.

• Non-specific GI symptoms: Nausea, vomiting, and diarrhoea.

• Blood tests: Often normal but might show signs of malnutrition or malabsorption.

• CT angiography: Gold standard for visualising vascular occlusions or stenosis.

• Conventional angiography: Invasive but offers therapeutic opportunities.

• Revascularisation: Surgical bypass or angioplasty and stenting to restore blood flow.

• Medication: Antiplatelets or anticoagulants to prevent clot formation.

• Conservative management: Optimising cardiac function and dietary changes to reduce fat which requires more blood for digestion.

• Untreated mesenteric angina can progress to mesenteric infarction – a surgical emergency with high mortality.

• Early diagnosis and intervention improves outcomes.