Document Detail


What is the best diagnostic approach for chronic gastrointestinal ischemia?
MedLine Citation:
PMID:  17573786     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Chronic gastrointestinal ischemia is still a difficult diagnosis to establish. The diagnosis depends on a high degree of clinical suspicion as well as selective angiography. Duplex sonography may serve as a screening tool, providing information on splanchnic vessel patency and flow patterns. GET is a minimally invasive test that can be used for diagnosis in patients with chronic gastrointestinal ischemia, and can differentiate between symptomatic and asymptomatic splanchnic artery stenosis. In the present study, we compared four different diagnostic approaches. METHODS: Between 1997 and 2000, 84 patients were evaluated for suspected chronic gastrointestinal ischemia. All underwent splanchnic arterial angiography, duplex sonography, and GET. For the presence or absence of stenosis, angiography was used as the gold standard. For diagnosing ischemia, we relied on a panel decision. The diagnostic approaches studied were: (a) angiography, only in patients with classic abdominal angina; (b) screening with duplex sonography, angiography if sonography abnormal or unreliable; (c) screening with gastric tonometry and angiography if tonometry not normal; (d) both gastric tonometry exercise and duplex sonography, angiography if one of both screening tests not normal. RESULTS: In 28 patients, chronic gastrointestinal ischemia was diagnosed. Using clinical suspicion only, 16 patients (57%) would have been missed. Screening by duplex sonography or gastric tonometry only would have missed 4 or 6 patients, respectively. Screening with combined gastric tonometry and duplex sonography would not have missed patients with symptomatic ischemia, while 21% of angiographies would have been avoided. CONCLUSION: Screening by combined GET and duplex sonography has excellent diagnostic accuracy. Currently, this approach represents the best diagnostic workup strategy in patients with suspected chronic gastrointestinal ischemia.
Authors:
Johannes A Otte; Robert H Geelkerken; Ad B Huisman; Jeroen J Kolkman
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-06-15
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  102     ISSN:  0002-9270     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  2007 Sep 
Date Detail:
Created Date:  2007-08-30     Completed Date:  2007-10-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2005-10     Citation Subset:  IM    
Affiliation:
Departments of Internal Medicine and Gastroenterology, Medisch Spectrum Twente, Enschede, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Angiography, Digital Subtraction
Blood Flow Velocity
Exercise
Female
Gastrointestinal Tract / blood supply*
Humans
Ischemia / diagnosis*
Male
Manometry
Middle Aged
Splanchnic Circulation
Ultrasonography, Doppler, Duplex

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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