Abdominal angina

Abdominal angina
Other names	Intestinal angina
CT angiogram demonstrating stenosis of the superior mesenteric artery.
Specialty	General surgery

Abdominal angina is abdominal pain after eating caused by a reduction of blood flow to inferior mesenteric artery (IMA), celiac trunk,  superior mesenteric arteries (SMA), or the surrounding organs.^[1] Symptoms include abdominal pain, weight loss, diarrhea, nausea, vomiting, and an aversion or fear of eating caused by the pain associated with eating.

Abdominal angina is caused by obstruction or stenosis of the inferior mesenteric artery, celiac trunk, or superior mesenteric artery. Gender, age, smoking, hypertension, diabetes, and hyperlipidemia are risk factors for abdominal angina. The digestive tract relies on the celiac, superior mesenteric, and inferior mesenteric arteries for blood flow. Abdominal pain occurs when these arteries fail to provide adequate blood flow. The gastrointestinal system has collateral circulation, which can worsen with vascular stenosis. The number of arteries required for ischemia symptoms is debatable, and angina occurrence is determined by other factors such as location of the affected arteries, time, and concurrent disorders.

Abdominal angina is diagnosed using imaging to identify stenosis. Differential diagnoses include GERD, dietary sensitivities, constipation, pancreatitis, abdominal abscess, appendicitis, irritable bowel syndrome, gastroenteritis, hepatitis, and gastrointestinal system inflammation. Duplex ultrasound, MR angiography, angiography, and CT angiography can help confirm the diagnosis of abdominal angina. Abdominal angina is treated based on severity and cause. Chronic mesenteric ischemia requires surgical revascularization and treatment like stents, transaortic endarterectomy, or bypassing the arteries.

Abdominal angina often has a one-year delay between symptoms and treatment, leading to complications like malnutrition or bowel infarction. Abdominal angina is more prevalent in females with a 3:1 ratio, and the average age of onset is 60 years. Abdominal angina was first described by Dr. Baccelli in 1918 as lower abdominal pain after eating. Dunphy connected it to gastrointestinal necrosis in 1936, and 21 years later, Mikkelson introduced surgery to restore blood flow.