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Ischemic Bowel Disease
Ischemia results when the tissue is deprived of oxygen. In the case of ischemic bowel disease, there is a narrowing of the blood vessels which supply the intestines with oxygen rich blood. The narrowing (and blockage) of the vessels is secondary to the effects of atherosclerotic vascular disease. It is oxygen deprivation that results in the symptoms of ischemic bowel disease. This problem is much more common in the patient over 50 who already has significant atherosclerotic vascular disease (history for prior heart attack or stroke). Patients with risk factors for the acceleration of atherosclerosis (i.e. diabetes, high blood pressure, smokers, and high blood cholesterol) are at highest risk for ischemic bowel disease. Common symptoms include a cramping abdominal pain that is worse after meals. The patient may notice blood mixed in the stools or the stools may test positive for occult blood. Evaluation includes history and physical examination. Testing of the stools will often reveal the presence of blood. The patient with suspected ischemic bowel disease may undergo angiography of the mesenteric vessels (those which supply the intestine). Angiography involves the injection of a radiopaque contrast (visible on x-ray) into the diseased vessels to determine the extent of the narrowing or blockage. Treatment is aimed at prescribing medications that improve blood flow to the intestines. Some patients may be placed on blood thinning medications (warfarin). Complete closure of a vessel may require a surgical procedure to correct the problem. New procedures, involving the injection of clot dissolving medications (thrombolytic agents) into the precise area of the blockage (via a thin hollow tube introduced through a blood vessel in the groin) have been successful in some cases. This progressive disease is quite difficult to treat. A low fat diet is suggested in these patients.
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