Is your intestines also experiencing reduced blood flow? This is called Mesenteric Ischemia!

Have you ever had a sudden, unbearable stomachache? Or do you feel like you have a stomachache after eating and it seems to get worse? If you have symptoms like these, it may be due to a rare but potentially dangerous condition. We are going to talk about one such condition today. It is called Mesenteric Ischemia . Don't worry, we will talk about this simply and in a way that you can understand.

What is this mesenteric ischemia?

Simply put, mesenteric ischemia is when parts of your digestive system don't get enough blood . It's like when the water in your tap is running low. This is usually caused by a blockage in the blood vessels that supply blood to those parts.

This condition is more common in older people, especially those with heart disease or blood clotting disorders.

Think about it, every cell, every tissue, and every organ in our body needs oxygen. This oxygen comes from the blood. So, when blood circulation is impaired, those organs and tissues do not have enough oxygen and cannot function properly. If the blockage is severe, those organs and tissues can even start to die . This can often be a fatal condition. Therefore, it is very important to diagnose and treat the disease as soon as possible.

What do the words "mesentery" and "ischemia" mean?

• Mesentery: This is a membrane-like organ inside our abdomen. It is what holds our small intestine, large intestine, and several other organs in place. Also, a network of blood vessels runs through this mesentery that supplies blood to those organs.
• Ischemia: This is when a part of our body does not receive enough blood flow.

Mesenteric ischemia means that this decreased blood flow affects your mesentery and its associated organs.

Are there types of this?

Yes, there are mainly two types of mesenteric ischemia:

1. Acute Mesenteric Ischemia

Like a heart attack or a stroke, this is a sudden condition. It is caused by a blockage in a major artery, just like this one. It is usually caused by blood clots . The symptoms come on suddenly and are very severe. This is a medical emergency that requires immediate treatment .

2. Chronic Mesenteric Ischemia (Chronic Mesenteric Ischemia)

This type develops slowly over time. It's usually caused by a gradual narrowing of your mesenteric arteries. Symptoms tend to get worse over time.

Who is more likely to develop this? (Risk factors)

Mesenteric ischemia is more common with age. It is also associated with heart disease and circulatory system diseases, especially conditions that can cause blood clots.

Here are some risk factors:

• Heart rhythm disorders, for example , atrial fibrillation .
• Coronary artery disease .
• Diabetes (Diabetes Mellitus) .
• Heart failure .
• High blood pressure (Hypertension) .
• High cholesterol level in the blood (Hyperlipidemia) .
• Hypercoagulation disorders .
• Recent surgery.
• Diseases of the blood vessels in the limbs, for example , peripheral artery disease .
• Tobacco use - whether you used it in the past or are currently using it.

This disease is not very common. It occurs in about 1 or 2 out of 1,000 hospitalized patients.

How does this disease affect the body? Why is it dangerous?

Every cell, tissue, and organ in our body needs a constant supply of blood and oxygen. If that supply is lost, they begin to die. The main reason why mesenteric ischemia is dangerous is that it affects our intestines . There are trillions of bacteria inside our intestines.

Normally, these bacteria are good for us, helping us digest the food we eat. But when the intestines start to die, these bacteria can spread to places they shouldn't be and cause dangerous infections . This can lead to a life-threatening condition called sepsis . Sepsis is when our immune system overreacts to an infection, causing damage to our own body.

What causes this?

There are different causes for different types of mesenteric ischemia.

Causes of Acute Mesenteric Ischemia:

A waxy substance called plaque can build up inside our arteries, causing them to harden. This is called atherosclerosis . This is commonly seen with heart disease. If one of these plaques ruptures, a blood clot can form.

Ways blood clots can cause blockages:

• A blood clot in your mesenteric artery (15% - 25%): Some medical conditions make it easier for blood clots to form in your blood vessels. If such a clot forms in your mesenteric artery, it can cause acute mesenteric ischemia.
• Mesenteric artery embolism (50%): This occurs when a blood clot that has formed elsewhere in the body breaks loose and becomes lodged in a mesenteric artery. Blood cannot flow past the clot.
• Blood clots in the mesenteric veins (5%): This can happen to people who have conditions that make their blood clot easily (such as hereditary conditions). When a clot forms in the mesenteric veins, blood flow is blocked, and blood fills the space behind the clot. This is more common in younger people.

There is also a type called non-occlusive mesenteric ischemia (NOMI) . About 20% of patients with acute mesenteric ischemia fall into this category. This is caused by a constriction or spasm of the blood vessels. This can have several causes:

• Drugs: Some heart medications can cause blood vessels to narrow, as can drugs like cocaine.
• Medical procedures: Things like dialysis and surgery can cause the mesenteric blood vessels to constrict.
• Health conditions: This condition can be caused by things like sepsis, heart failure, dehydration, allergic reactions, etc. Low blood pressure can also contribute to this.

This NOMI situation took a while to get worse, but it's still dangerous.

Causes of Chronic Mesenteric Ischemia:

This is often caused by circulatory diseases that narrow the blood vessels. This narrowing, also called stenosis , reduces the amount of blood flowing to the mesentery over time.

It can also be caused by a blood clot forming in a mesenteric blood vessel. If this happens, the clot can grow larger and symptoms may increase over a period of days or weeks.

Although this chronic condition is not immediately life-threatening, about 40% of patients with acute mesenteric ischemia have preexisting chronic symptoms. That is, symptoms caused by narrowed blood vessels suddenly worsen when those vessels become blocked by a new blood clot.

What are the symptoms of this?

The symptoms of mesenteric ischemia vary depending on the type.

Symptoms of Acute Mesenteric Ischemia:

The symptoms of this condition come on suddenly. They are:

• Severe abdominal pain: This is the most common symptom (75% - 80% of patients have it). It usually occurs after eating. It is difficult to tell exactly where in the stomach it is, but the pain can be very severe . The patient may say that when a doctor feels the stomach, it hurts much more than expected. This may be the only symptom in NOMI.
• Bloating, nausea, and vomiting: These usually accompany stomach pain. Vomiting is also common in many people (about 70%).
• Changes in bowel movements: This can be caused by things like constipation.
• Diarrhea: About 40% of patients have it. But it can be intermittent, not continuous. Diarrhea can be very severe, followed by severe cramps. Bloody diarrhea is common in the severe stages of the disease.
• Weight loss: This can also be seen in acute cases. It may be due to aversion to food due to pain or other symptoms that precede the onset of the disease.
• Fever: This could be a sign of a dangerous infection.

Often, symptoms of chronic mesenteric ischemia (see below) may precede the onset of this acute condition. About half of acute patients have chronic symptoms first.

Symptoms of Chronic Mesenteric Ischemia:

The symptoms of this condition appear slowly and increase over time.

• Stomach ache: This is most common an hour or two after eating. It can feel like something is pressing on your stomach (cramps). The pain usually occurs in the upper abdomen or around the belly button.
• Fear of eating and weight loss: As the disease progresses, the pain becomes more severe. This can lead to a condition called "food fear." This means avoiding food because you think it will hurt after eating. This naturally leads to weight loss .
• Change in toilet habits: Needing to go to the toilet more or less than before.
• Diarrhea: This occurs in about one-third of patients. It is usually chronic diarrhea.

How do doctors diagnose this? (Diagnosis)

A doctor diagnoses mesenteric ischemia through a combination of physical examination, lab tests, and imaging tests. Unfortunately, this condition is difficult to diagnose in its early stages. Another challenge is that many people with this condition are unable to speak or answer questions properly, especially when they are in severe pain.

What kind of tests are done?

There are several tests that can help diagnose this disease:

Physical examination

This is where your doctor looks, feels, and listens to you to see if there are any problems. In mesenteric ischemia, doctors may find things like:

• Visible signs: Bloating is one of the main signs. Some people may notice weight loss. Many people may lie in a fetal position due to severe pain.
• Signs that you can feel: The doctor will palpate your abdomen. Some people experience tenderness in certain areas of their abdomen. Many people will tense up when the doctor tries to touch their abdomen (guarding). Often, patients say that it hurts more than just touching their abdomen.
• Audible signs: The doctor will listen to the sounds of your digestive system with a stethoscope. These sounds, called borborygmi , are less audible in mesenteric ischemia. In severe cases, there may be no sound at all. Sometimes, a bruit may be heard. This is a sound that is heard with some blood clots.

These physical tests may not detect anything significant until the disease is very advanced. So it takes a long time to diagnose this disease, which is one of the reasons why it is so dangerous.

Laboratory tests

These tests look for changes in the blood, especially its oxygen content and ability to clot. They also look at how the immune system is responding to an infection. Other tests look for chemicals that accumulate in the blood as a result of damaged or dying cells and tissues.

Imaging and Endoscopy

The best way to diagnose mesenteric ischemia is to look for areas of reduced or absent blood flow. Several imaging tests can help with this:

• Ultrasound: This involves sending high-frequency sound waves through a device that is placed on the skin of your abdomen. These sound waves work in much the same way that bats "see," creating a picture that helps doctors find areas where blood flow is slow or absent. Different types of ultrasound can also measure how much blood is flowing through different blood vessels.
• Angiography: This is the best and most reliable way to diagnose mesenteric ischemia. In angiography, a dye called contrast is injected into the major blood vessels in your abdomen. The vessels then show up clearly on an X-ray or CT scan . It can also show partially or completely blocked vessels. Sometimes, a catheter , a long, tube-like device, is inserted into a major blood vessel and the affected blood vessel can be viewed from inside.
• Endoscopy: In this procedure, a doctor inserts a thin, flexible tube called an endoscope into your digestive tract to look for signs of ischemia. If the problem is near the stomach, the endoscope is inserted through your mouth and passed down into the small intestine. If the problem is in the large intestine or lower part of the small intestine, the endoscope is inserted through your rectum (similar to a colonoscopy). Anesthesia is usually used for these procedures. Endoscopy is more likely to be performed for people who cannot have a contrast injection (for example, those with allergies or kidney problems).

Is there a treatment for this? Can it be cured?

Yes, mesenteric ischemia can be treated and reversed if caught early .

The first thing to do is to restore blood flow as quickly as possible. Because mesenteric ischemia becomes dangerous over time, doctors may recommend surgery immediately.

Once blood flow is restored, the next step is to check for any damaged or dead tissue. If parts of the intestine or colon have died from lack of blood supply, removing those parts is the only way to repair the damage and prevent life-threatening complications.

What treatments and medications are given?

The treatments and interventions vary depending on the type of mesenteric ischemia and the location of the cause.

Treatment of Acute Mesenteric Ischemia:

The most effective treatment for this is surgery , as the surgeon can directly remove the blood clot, widen the narrowed blood vessel, or insert a stent , a frame-like structure that keeps the blood vessel open.

In cases where it is not possible to restore blood flow directly, the surgeon may take a piece of blood vessel from another part of your body and create a bypass . The bypass bypasses the blocked area and restores blood flow.

After the blood flow is restored, the surgeon will check the surrounding tissue for signs of damage. If there are any dead or damaged areas, they will remove them and repair the area so that it can function properly in the future. This often requires a second surgery, as it can take up to two days for some of the dead or damaged tissue to become visible.

Medications and other supportive treatments typically include:

• Intravenous (IV) fluids: These can help if low blood pressure or dehydration is a problem.
• Blood transfusions: This is very important if a lot of blood has been lost.
• Oxygen: This reduces the effort your body has to make to circulate blood.
• Antibiotics: These are essential with intestinal surgery, as the risk of infection is higher due to the bacteria that normally reside in those organs.
• Blood thinners: These medications prevent blood clots from forming. This not only prevents mesenteric ischemia from recurring, but also prevents heart attacks, strokes, and pulmonary embolisms. However, blood thinners are not given to people who are at risk of severe bleeding.

Treatment for Non-occlusive mesenteric ischemia (NOMI):

Although this is a subtype of acute mesenteric ischemia, surgery is not always necessary to correct this problem (and it may not be very helpful initially), because NOMI usually involves narrowing of the blood vessels without any actual blockage.

The most important thing in NOMI is to find the cause of the narrowing of the vessels, treat it, and prevent it from happening again. This means stopping the medications or drugs that caused the narrowing of the blood vessels. If the cause of NOMI is another disease, such as sepsis, treating that disease will also improve blood flow to the mesentery.

If NOMI is accompanied by narrowing of the blood vessels, a procedure called balloon angioplasty may help. In this procedure, a catheter is inserted into a major blood vessel and guided to the affected area. There, a balloon at the end of the catheter is inflated, widening the affected blood vessel.

Other treatments:

• Vasodilators: These medications widen your blood vessels, allowing blood to flow more easily.
• Antibiotics: These are important even if you don't have surgery, because any time there is damage to the intestines, there is a risk of infection.
• Oxygen: Reduces the effort the body has to put into circulating blood.

Treatment for Chronic Mesenteric Ischemia:

Treatment for this may vary slightly depending on the cause, but most treatments are similar to those for acute mesenteric ischemia.

Surgery is common for this, especially if there is a slow-growing blood clot or a severely narrowed blood vessel. Surgery is also more likely to be required if there is internal bleeding, infection, sepsis, or other serious complications. Bypass surgery may also be performed if other methods cannot restore blood flow.

Balloon angioplasty and other catheter-based procedures are also being considered for this condition. In most cases, doctors recommend catheter-based procedures over surgery whenever possible. Because surgery is less invasive, the recovery from catheter-based procedures is easier.

The medications given for this are largely the same as those given for acute cases. It is also common to give blood-thinning medications when blood clots are causing blockages without moving them.

What are the complications of this disease and treatment?

The complications and side effects of this procedure vary depending on the treatment you receive. Your doctor can best explain the specific side effects and complications you may experience.

In general, these complications can occur with mesenteric ischemia:

• Sepsis: This is a widespread infection that causes your immune system to overreact and cause life-threatening damage to your body.
• Your intestines or colon rupture or burst: This can happen when parts of the organ that are dead or dying start to break down.
• Weight loss: This is more likely to occur in chronic mesenteric ischemia, but can also occur in acute cases (especially in someone who had chronic symptoms before the sudden exacerbation).

Possible complications of surgery for mesenteric ischemia:

• Digestive problems after surgery.
• Constipation or diarrhea.
• Bleeding.
• Infections.
• Kidney failure .
• Heart attack or stroke (within a few months after surgery).

Nutritional problems can occur after parts of the small intestine are removed. When parts of the small intestine are missing, it is difficult to absorb nutrients from food. Many people with this condition , called short bowel syndrome, require special feeding methods, such as a feeding tube.

How can I take care of myself and manage my symptoms?

If you have mesenteric ischemia, you need immediate medical attention (especially if it is a sudden, acute type). If you have chronic mesenteric ischemia, you should treat the condition as directed by your doctor. Do not try to treat it yourself , as this can be a life-threatening emergency.

How quickly will I recover after treatment?

If the disease is diagnosed and treated early, most people will begin to recover once blood flow to the affected area improves. Others may begin to recover in a few days or weeks.

For those who have had surgery, it takes a while to recover. Because surgery is a serious thing, it takes time to heal.

How can I reduce the risk of this happening?

There are several things you can do to reduce your risk of developing mesenteric ischemia. Many of these include preventing or avoiding conditions that increase the risk of developing mesenteric ischemia.

Things you can do:

• Get an annual checkup: This can help your doctor catch early signs of things like heart disease, high blood pressure, and high cholesterol. Catching these before symptoms appear can make a big difference in preventing serious problems like mesenteric ischemia.
• Quit smoking: This includes vaping and chewing tobacco. If you don't use tobacco, don't start. Tobacco use can damage your blood vessels and greatly increase your risk of developing problems like mesenteric ischemia.
• Take your medications correctly: If you have high blood pressure, high cholesterol, or diabetes, taking your medications correctly can help prevent damage that can lead to mesenteric ischemia.
• Eat a healthy, balanced diet: Many of the problems that can lead to mesenteric ischemia are related to your weight and your diet. Foods that are high in fat or sodium can increase your cholesterol and blood pressure, both of which are risk factors for mesenteric ischemia.
• Stay active: Physical activity is important for the health of your heart and circulatory system, as well as for maintaining a healthy weight.

Can this be prevented from happening?

Many of the measures that can help prevent mesenteric ischemia are similar to those that can reduce the risk. However, unfortunately, in some cases – especially if you have an injury or a condition that makes your blood clot easily – prevention is not possible.

What happens if you develop this disease? What can you expect going forward?

Unfortunately, mesenteric ischemia, regardless of its type, is a difficult disease to diagnose. Waiting for a diagnosis can delay treatment. If treatment is not received quickly, acute mesenteric ischemia is often fatal. The mortality rate for the acute form of the disease is between 50% and 80% , especially if treatment is delayed. If treatment is received within 12 hours of the onset of the blockage, the mortality rate can be as low as 14%. Chronic mesenteric ischemia can also have long-term adverse effects, either due to the risk of blood flow problems or nutritional deficiencies.

People with mesenteric ischemia are also at increased risk of developing other ischemia-related conditions, such as heart attack, stroke, and pulmonary embolism. Regular follow-up visits with your doctor are important to prevent long-term problems and reduce the risk of developing other life-threatening conditions.

How long will this situation last?

Acute mesenteric ischemia is a short-term condition, as it is usually fatal (if left untreated). Chronic mesenteric ischemia can take days or weeks to develop. However, treatment for this condition – especially early treatment – ​​can usually reverse the condition within a few hours.

When can I go back to work/school?

Your doctor can best tell you about your recovery schedule. Depending on the severity of your condition and the treatment you receive, most people can return to normal activities within a few days or weeks. In severe cases, especially after surgery, it may take longer.

How do I take care of myself (after recovery)?

After you have mesenteric ischemia, it's very important to follow your doctor's instructions. He or she is the best person to guide you on how to take care of yourself and prevent further problems.

Typically, you should do these things:

• See your doctor as recommended: Follow-up visits can make a big difference in catching complications or other problems related to this disease.
• Take your medications exactly as directed: This is especially true for medications related to your heart, circulatory system, diabetes, cholesterol, or your blood clotting ability.
• Stop smoking, or don't start: Smoking is a major risk factor for mesenteric ischemia because it damages your blood vessels. It also makes it easier for blood clots to form, which can block important blood vessels.
• Follow your doctor's advice about diet and activity: These recommendations will help improve your overall health, as well as reduce the risk of mesenteric ischemia recurring.

When should I see a doctor?

If the symptoms of mesenteric ischemia come back, change, or become severe, you should see your doctor. Also, ask him or her about any special warning signs or symptoms that you should call his or her office for, or seek medical attention.

When should I go to the hospital urgently? (Emergencies)

You should seek medical attention immediately if your chronic symptoms suddenly change or become severe, or if you have any symptoms of acute mesenteric ischemia.

Acute symptoms are:

• Stomach ache (especially if it starts suddenly).
• Stomach bloating, nausea, and vomiting.
• Changes in toilet habits (how often you go).
• Severe or frequent diarrhea.
• Sudden weight loss.

Finally, things to remember (Take-Home Message)

Mesenteric ischemia can be a scary condition, especially when it strikes suddenly. Fortunately, modern medicine has made great strides in early diagnosis and treatment. There are also steps you can take to reduce your risk of developing the condition and prevent it from recurring once you've recovered. The best thing you can do is to know your risks and manage them. Your doctor can help you with both of these goals. He or she can help you recover from the condition or prevent it altogether.

Never underestimate a severe stomach ache. If in doubt, seek medical advice immediately.

` Mesenteric ischemia, abdominal pain, decreased blood flow, intestinal diseases, acute ischemia, chronic ischemia, blood vessel occlusion