Abdominal pain that always appears shortly after eating, to the point of becoming afraid to eat and eventually losing weight, can have a little-known vascular origin: chronic mesenteric ischemia, that is, a lack of blood flow to the intestine.
What chronic mesenteric ischemia is
It is the narrowing of the arteries that supply the intestine (the mesenteric arteries and the celiac trunk), which reduces the blood supply. The most common cause is atherosclerosis, the same process that affects the arteries of the heart or the legs.
Because atherosclerosis acts systemically, several abdominal arteries are usually affected. The intestine has collateral circulation and connecting networks, so symptoms appear when the narrowing is significant and/or affects several vessels.
Symptoms: intestinal angina
The characteristic symptom is abdominal pain that appears shortly after eating, usually between 15 and 30 minutes later. It is called intestinal angina because of its similarity to angina of the chest: the intestine demands more blood to digest food and doesn't receive it.
- Pain in the central or upper abdomen after meals.
- Nausea, heavy digestion, loose stools or even vomiting.
- Fear of eating from anticipating the pain, which leads to eating less.
- Progressive weight loss and, sometimes, changes in bowel habits.
Why it is hard to diagnose
Abdominal pain has many causes, so this diagnosis is usually reached after ruling out more common digestive problems. It should be distinguished from other causes of pain after eating, such as median arcuate ligament syndrome: there the artery is compressed by a ligament, it affects younger people more, and it isn't due to atherosclerosis, although it isn't uncommon for both to occur together. Chronic mesenteric ischemia occurs mainly in older people with vascular risk factors.
When an older person, with cardiovascular risk factors or diseased arteries in the legs or heart, tells me they are eating less because of pain and have lost weight, I think of the visceral arteries. It's a diagnosis that is easily overlooked.
Diagnosis and treatment
Diagnosis combines the clinical picture with imaging tests: Doppler ultrasound assesses the blood flow in the arteries and CT angiography shows the narrowing in detail. Once confirmed and with symptoms present, the goal is to restore blood flow.
Today the usual approach is endovascular: through catheterization the narrowed artery is widened and a stent is placed (angioplasty, stenting), a minimally invasive procedure. In some cases surgery is considered, using bypass or other techniques. It is also essential to control risk factors (smoking, cholesterol, blood pressure, diabetes). You can find more context on the chronic mesenteric ischemia page.
In summary
Chronic mesenteric ischemia is a lack of blood flow to the intestine caused by narrowing of its arteries, almost always due to atherosclerosis. It causes pain when eating, digestive symptoms and weight loss. When it produces symptoms, endovascular treatment with stenting restores blood flow. If you experience this pattern of pain after eating, a vascular assessment can provide the missing piece.