Medicines for Mesenteric ischaemia

What it is

Mesenteric ischaemia is a condition in which the blood supply to the intestines (through the mesenteric arteries) is reduced or blocked, so the bowel does not get enough oxygen. It occurs in two main forms. Acute mesenteric ischaemia is a sudden, severe reduction or blockage of blood flow — usually from a blood clot (which may travel from the heart, for example with an irregular heart rhythm, or form on narrowed arteries) or, sometimes, a fall in blood flow in critically ill people. It is a life-threatening emergency, because without a blood supply the bowel tissue rapidly begins to die, which can be fatal if not treated quickly. A classic (though not always present) feature is severe tummy pain that is out of proportion to the findings on examination — the person is in a lot of pain, but the tummy may not feel as bad as expected early on. Chronic mesenteric ischaemia is a longer-term, partial narrowing of the arteries (usually from atherosclerosis), causing a different pattern: recurrent tummy pain that comes on after eating (when the bowel needs more blood, sometimes called "intestinal angina"), leading to a fear of eating and weight loss over time. Both forms are serious and, particularly the acute form, need prompt recognition, as delays greatly worsen the outcome.

How it is treated

The approach depends on whether it is acute or chronic. Acute mesenteric ischaemia is a medical and surgical emergency requiring immediate hospital assessment and treatment, as survival and saving the bowel depend on speed. It is diagnosed urgently (often with a CT scan of the blood vessels), and treatment aims to restore blood flow as quickly as possible — with measures to open the blocked artery (such as surgery or techniques to remove or dissolve the clot, or angioplasty/stenting), and, where bowel has already been damaged, surgery to remove the dead segment. Supportive care (fluids, blood-thinning, and intensive support) is given. Because it can be difficult to diagnose and progresses rapidly, a high level of suspicion — for example severe tummy pain out of proportion to examination, particularly in an older person with heart disease or an irregular heart rhythm — is important. Chronic mesenteric ischaemia is managed by improving the blood flow to the bowel, usually with a procedure to widen or bypass the narrowed arteries (such as angioplasty and stenting, or surgery), along with managing the underlying atherosclerosis (stopping smoking, and controlling cardiovascular risk factors). The reassuring message is that mesenteric ischaemia is treatable — the acute form is a time-critical emergency where prompt treatment to restore blood flow can be life- and bowel-saving, and the chronic form can be treated by improving the bowel's blood supply — so severe or eating-related tummy pain, especially in those with cardiovascular risk, needs prompt assessment.