Combining radiological imaging and gastrointestinal tonometry: a minimal invasive and useful approach for the workup of chronic gastrointestinal ischemia

Desiree van Noord; Aria Sana; Leon M. Moons; Peter M. Pattynama; Hence J. Verhagen; Ernst J. Kuipers; Peter B. Mensink

doi:10.1097/MEG.0b013e32835ddc45

Combining radiological imaging and gastrointestinal tonometry: a minimal invasive and useful approach for the workup of chronic gastrointestinal ischemia

Desiree van Noord^*, Aria Sana, Leon M. Moons, Peter M. Pattynama, Hence J. Verhagen, Ernst J. Kuipers, Peter B. Mensink

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background The established approach for patients suspected of chronic gastrointestinal ischemia (CGI) includes assessment of medical history, vascular imaging, such as by digital subtraction angiography, and, more recently, computed tomography angiography (CTA) or magnetic resonance angiography. Mucosal perfusion assessment techniques have recently been shown to be of additional diagnostic value, including visible light spectroscopy and gastric exercise tonometry. Gastric exercise tonometry, however, is cumbersome and impossible to perform in a considerable proportion of patients. An alternative approach is provided by 24 h gastrointestinal tonometry (TM). We challenged the use of TM in combination with CTA as an alternative approach to evaluate patients suspected of CGI.

Methods Patients referred for suspected CGI were prospectively evaluated using CTA and TM, and discussed in a multidisciplinary team, where a consensus diagnosis was made. CGI patients were offered therapy. Persistent symptom relief after adequate therapy during follow-up was used as the 'gold standard' and was defined as a definitive diagnosis of CGI.

Results In 31 months, 186 patients were included (men 69, mean age 63 years). A consensus diagnosis of CGI was made in 128 (69%) patients: 94 with occlusive and 34 with nonocclusive CGI. After a median follow-up of 21 months after a therapeutical intervention, 91% of the CGI patients were free from symptoms.

Conclusion In patients clinically suspected of CGI, the combination of CTA and TM provides a minimally invasive, reliable diagnostic approach, which seems to be very useful in clinical practice and to have an outcome similar to the established diagnostic workup. Eur J Gastroenterol Hepatol 25: 719-725 (C) 2013 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins. European Journal of Gastroenterology & Hepatology 2013, 25: 719-725

Original language	English
Pages (from-to)	719-725
Number of pages	7
Journal	European Journal of Gastroenterology and Hepatology
Volume	25
Issue number	6
DOIs	https://doi.org/10.1097/MEG.0b013e32835ddc45
Publication status	Published - Jun 2013

Keywords

chronic gastrointestinal ischemia
chronic mesenteric ischemia
computed tomography angiography
gastrointestinal tonometry
ARTERY COMPRESSION SYNDROME
GASTRIC EXERCISE TONOMETRY
MESENTERIC ISCHEMIA
CT ANGIOGRAPHY
MANAGEMENT
DIAGNOSIS
VARIABILITY
DISEASE

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10.1097/MEG.0b013e32835ddc45

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van Noord, D., Sana, A., Moons, L. M., Pattynama, P. M., Verhagen, H. J., Kuipers, E. J., & Mensink, P. B. (2013). Combining radiological imaging and gastrointestinal tonometry: a minimal invasive and useful approach for the workup of chronic gastrointestinal ischemia. European Journal of Gastroenterology and Hepatology, 25(6), 719-725. https://doi.org/10.1097/MEG.0b013e32835ddc45

@article{86e3a40b3b684bda8e56193b45b9fb31,

title = "Combining radiological imaging and gastrointestinal tonometry: a minimal invasive and useful approach for the workup of chronic gastrointestinal ischemia",

abstract = "Background The established approach for patients suspected of chronic gastrointestinal ischemia (CGI) includes assessment of medical history, vascular imaging, such as by digital subtraction angiography, and, more recently, computed tomography angiography (CTA) or magnetic resonance angiography. Mucosal perfusion assessment techniques have recently been shown to be of additional diagnostic value, including visible light spectroscopy and gastric exercise tonometry. Gastric exercise tonometry, however, is cumbersome and impossible to perform in a considerable proportion of patients. An alternative approach is provided by 24 h gastrointestinal tonometry (TM). We challenged the use of TM in combination with CTA as an alternative approach to evaluate patients suspected of CGI.Methods Patients referred for suspected CGI were prospectively evaluated using CTA and TM, and discussed in a multidisciplinary team, where a consensus diagnosis was made. CGI patients were offered therapy. Persistent symptom relief after adequate therapy during follow-up was used as the 'gold standard' and was defined as a definitive diagnosis of CGI.Results In 31 months, 186 patients were included (men 69, mean age 63 years). A consensus diagnosis of CGI was made in 128 (69%) patients: 94 with occlusive and 34 with nonocclusive CGI. After a median follow-up of 21 months after a therapeutical intervention, 91% of the CGI patients were free from symptoms.Conclusion In patients clinically suspected of CGI, the combination of CTA and TM provides a minimally invasive, reliable diagnostic approach, which seems to be very useful in clinical practice and to have an outcome similar to the established diagnostic workup. Eur J Gastroenterol Hepatol 25: 719-725 (C) 2013 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins. European Journal of Gastroenterology & Hepatology 2013, 25: 719-725",

keywords = "chronic gastrointestinal ischemia, chronic mesenteric ischemia, computed tomography angiography, gastrointestinal tonometry, ARTERY COMPRESSION SYNDROME, GASTRIC EXERCISE TONOMETRY, MESENTERIC ISCHEMIA, CT ANGIOGRAPHY, MANAGEMENT, DIAGNOSIS, VARIABILITY, DISEASE",

author = "{van Noord}, Desiree and Aria Sana and Moons, {Leon M.} and Pattynama, {Peter M.} and Verhagen, {Hence J.} and Kuipers, {Ernst J.} and Mensink, {Peter B.}",

year = "2013",

month = jun,

doi = "10.1097/MEG.0b013e32835ddc45",

language = "English",

volume = "25",

pages = "719--725",

journal = "European Journal of Gastroenterology and Hepatology",

issn = "0954-691X",

publisher = "Lippincott Williams & Wilkins",

number = "6",

}

van Noord, D, Sana, A, Moons, LM, Pattynama, PM, Verhagen, HJ, Kuipers, EJ & Mensink, PB 2013, 'Combining radiological imaging and gastrointestinal tonometry: a minimal invasive and useful approach for the workup of chronic gastrointestinal ischemia', European Journal of Gastroenterology and Hepatology, vol. 25, no. 6, pp. 719-725. https://doi.org/10.1097/MEG.0b013e32835ddc45

Combining radiological imaging and gastrointestinal tonometry: a minimal invasive and useful approach for the workup of chronic gastrointestinal ischemia. / van Noord, Desiree; Sana, Aria; Moons, Leon M. et al.
In: European Journal of Gastroenterology and Hepatology, Vol. 25, No. 6, 06.2013, p. 719-725.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Combining radiological imaging and gastrointestinal tonometry

T2 - a minimal invasive and useful approach for the workup of chronic gastrointestinal ischemia

AU - van Noord, Desiree

AU - Sana, Aria

AU - Moons, Leon M.

AU - Pattynama, Peter M.

AU - Verhagen, Hence J.

AU - Kuipers, Ernst J.

AU - Mensink, Peter B.

PY - 2013/6

Y1 - 2013/6

N2 - Background The established approach for patients suspected of chronic gastrointestinal ischemia (CGI) includes assessment of medical history, vascular imaging, such as by digital subtraction angiography, and, more recently, computed tomography angiography (CTA) or magnetic resonance angiography. Mucosal perfusion assessment techniques have recently been shown to be of additional diagnostic value, including visible light spectroscopy and gastric exercise tonometry. Gastric exercise tonometry, however, is cumbersome and impossible to perform in a considerable proportion of patients. An alternative approach is provided by 24 h gastrointestinal tonometry (TM). We challenged the use of TM in combination with CTA as an alternative approach to evaluate patients suspected of CGI.Methods Patients referred for suspected CGI were prospectively evaluated using CTA and TM, and discussed in a multidisciplinary team, where a consensus diagnosis was made. CGI patients were offered therapy. Persistent symptom relief after adequate therapy during follow-up was used as the 'gold standard' and was defined as a definitive diagnosis of CGI.Results In 31 months, 186 patients were included (men 69, mean age 63 years). A consensus diagnosis of CGI was made in 128 (69%) patients: 94 with occlusive and 34 with nonocclusive CGI. After a median follow-up of 21 months after a therapeutical intervention, 91% of the CGI patients were free from symptoms.Conclusion In patients clinically suspected of CGI, the combination of CTA and TM provides a minimally invasive, reliable diagnostic approach, which seems to be very useful in clinical practice and to have an outcome similar to the established diagnostic workup. Eur J Gastroenterol Hepatol 25: 719-725 (C) 2013 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins. European Journal of Gastroenterology & Hepatology 2013, 25: 719-725

AB - Background The established approach for patients suspected of chronic gastrointestinal ischemia (CGI) includes assessment of medical history, vascular imaging, such as by digital subtraction angiography, and, more recently, computed tomography angiography (CTA) or magnetic resonance angiography. Mucosal perfusion assessment techniques have recently been shown to be of additional diagnostic value, including visible light spectroscopy and gastric exercise tonometry. Gastric exercise tonometry, however, is cumbersome and impossible to perform in a considerable proportion of patients. An alternative approach is provided by 24 h gastrointestinal tonometry (TM). We challenged the use of TM in combination with CTA as an alternative approach to evaluate patients suspected of CGI.Methods Patients referred for suspected CGI were prospectively evaluated using CTA and TM, and discussed in a multidisciplinary team, where a consensus diagnosis was made. CGI patients were offered therapy. Persistent symptom relief after adequate therapy during follow-up was used as the 'gold standard' and was defined as a definitive diagnosis of CGI.Results In 31 months, 186 patients were included (men 69, mean age 63 years). A consensus diagnosis of CGI was made in 128 (69%) patients: 94 with occlusive and 34 with nonocclusive CGI. After a median follow-up of 21 months after a therapeutical intervention, 91% of the CGI patients were free from symptoms.Conclusion In patients clinically suspected of CGI, the combination of CTA and TM provides a minimally invasive, reliable diagnostic approach, which seems to be very useful in clinical practice and to have an outcome similar to the established diagnostic workup. Eur J Gastroenterol Hepatol 25: 719-725 (C) 2013 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins. European Journal of Gastroenterology & Hepatology 2013, 25: 719-725

KW - chronic gastrointestinal ischemia

KW - chronic mesenteric ischemia

KW - computed tomography angiography

KW - gastrointestinal tonometry

KW - ARTERY COMPRESSION SYNDROME

KW - GASTRIC EXERCISE TONOMETRY

KW - MESENTERIC ISCHEMIA

KW - CT ANGIOGRAPHY

KW - MANAGEMENT

KW - DIAGNOSIS

KW - VARIABILITY

KW - DISEASE

U2 - 10.1097/MEG.0b013e32835ddc45

DO - 10.1097/MEG.0b013e32835ddc45

M3 - Article

C2 - 23395993

SN - 0954-691X

VL - 25

SP - 719

EP - 725

JO - European Journal of Gastroenterology and Hepatology

JF - European Journal of Gastroenterology and Hepatology

IS - 6

ER -

Combining radiological imaging and gastrointestinal tonometry: a minimal invasive and useful approach for the workup of chronic gastrointestinal ischemia

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Keywords

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