Intestinal angina is a wake-up call
DEAR DOCTOR K:
For years I've endured stomach pain after every meal. My doctor finally diagnosed me with intestinal angina. I've never even heard of this.
You've probably heard of cardiac angina. That's when cholesterol-filled plaque in the heart's arteries limits blood flow to a part of your heart muscle.
Typically, cardiac angina occurs when a person starts to exert himself, not at rest. Halfway up several flights of stairs, a squeezing pain may start in the middle of your chest. It goes away when you stop climbing the stairs. The cardiac angina occurs with exertion because the heart is working harder and isn't getting the blood supply it needs.
It's the same thing with intestinal angina. When you eat, your stomach and intestines stop resting and start to work. The wall of your intestines contains muscle that squeezes the food you've eaten and keeps it moving. If you have cholesterol-filled plaque in the arteries that supply blood to your intestine, the intestinal muscle -- like the heart muscle -- will start to "complain" that it isn't getting enough blood to work harder.
Your digestive system normally gets about one-quarter of the blood pumped out by your heart. After you eat, blood flow to the stomach and intestines almost doubles. In a healthy person, the digestive system handles this without missing a beat.
It's a different story when plaque causes severe narrowing in one or more of the major arteries supplying your gut. The mismatch in blood supply and demand can cause sharp abdominal pain after meals. It can also lead to diarrhea, nausea or vomiting after meals. These symptoms are the gut's version of angina. Thus the name: intestinal angina.
Treating intestinal angina requires restoring blood flow to the intestines. Many doctors do this with an angioplasty plus a stent, much as is done for narrowed arteries of the heart. Angioplasty enables doctors to open narrowed arteries with special instruments carrying inflatable balloons. Stents are tiny metal mesh tubes placed in the arteries to help keep them open.
Not only can the gut, like the heart, have angina; it can also experience its own version of a heart attack. If blood flow through an intestinal artery becomes completely blocked, intestinal tissue downstream from the blockage becomes depleted of oxygen and begins to die. Such blockages can permanently damage the intestines and even lead to death.
Doctors usually treat sudden blockage of an intestinal artery with emergency surgery. During surgery, doctors restore blood flow to the intestines and remove sections of the intestine that are dead or dying.
Intestinal angina is not a common cause of abdominal pain with meals. Much more common, for example, is gastrointestinal reflux disease (GERD) or ulcers of the stomach or intestine. But it does occur, as it apparently has in you. Like cardiac angina, intestinal angina is a wake-up call: It now is really important that you adopt a healthy lifestyle.
(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)
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