European guidelines on chronic mesenteric ischaemia - joint United European Gastroenterology, European Association for Gastroenterology, Endoscopy and Nutrition, European Society of Gastrointestinal and Abdominal Radiology, Netherlands Association of Hepatogastroenterologists, Hellenic Society of Gastroenterology, Cardiovascular and Interventional Radiological Society of Europe, and Dutch Mesenteric Ischemia Study group clinical guidelines on the diagnosis and treatment of patients with chronic mesenteric ischaemia

Luke G Terlouw, Adriaan Moelker, Jan Abrahamsen, Stefan Acosta, Olaf J Bakker, Iris Baumgartner, Louis Boyer, Olivier Corcos, Louisa Jd van Dijk, Mansur Duran, Robert H Geelkerken, Giulio Illuminati, Ralph W Jackson, Jussi M Kärkkäinen, Jeroen J Kolkman, Lars Lönn, Maria A Mazzei, Alexandre Nuzzo, Felice Pecoraro, Jan Raupach, Hence Jm Verhagen, Christoph J Zech, Desirée van Noord, Marco J Bruno, Luke G Terlouw, Adriaan Moelker, Jan Abrahamsen, Stefan Acosta, Olaf J Bakker, Iris Baumgartner, Louis Boyer, Olivier Corcos, Louisa Jd van Dijk, Mansur Duran, Robert H Geelkerken, Giulio Illuminati, Ralph W Jackson, Jussi M Kärkkäinen, Jeroen J Kolkman, Lars Lönn, Maria A Mazzei, Alexandre Nuzzo, Felice Pecoraro, Jan Raupach, Hence Jm Verhagen, Christoph J Zech, Desirée van Noord, Marco J Bruno

Abstract

Chronic mesenteric ischaemia is a severe and incapacitating disease, causing complaints of post-prandial pain, fear of eating and weight loss. Even though chronic mesenteric ischaemia may progress to acute mesenteric ischaemia, chronic mesenteric ischaemia remains an underappreciated and undertreated disease entity. Probable explanations are the lack of knowledge and awareness among physicians and the lack of a gold standard diagnostic test. The underappreciation of this disease results in diagnostic delays, underdiagnosis and undertreating of patients with chronic mesenteric ischaemia, potentially resulting in fatal acute mesenteric ischaemia. This guideline provides a comprehensive overview and repository of the current evidence and multidisciplinary expert agreement on pertinent issues regarding diagnosis and treatment, and provides guidance in the multidisciplinary field of chronic mesenteric ischaemia.

Keywords: Median arcuate ligament syndrome; atherosclerosis; coeliac artery release; mesenteric arteries; mesenteric artery stenting.

Figures

Figure 1.
Figure 1.
Anatomy of the arterial mesenteric circulation.
Figure 2.
Figure 2.
The most frequent causes of occlusive chronic mesenteric ischaemia (CMI) and chronic non-occlusive mesenteric ischaemia (NOMI). MALS: median arcuate ligament syndrome.
Figure 3.
Figure 3.
Celiac artery compression in median arcuate ligament syndrome (MALS).
Figure 4.
Figure 4.
Flowchart of the diagnostic work-up of patients with suspected chronic mesenteric ischaemia (CMI). CA: celiac artery; CE-MRA: contrast-enhanced magnetic resonance angiography; CTA: computed tomography angiography; DDx: differential diagnosis; GI: gastrointestinal; NOMI: non-occlusive mesenteric ischaemia; SMA: superior mesenteric artery.

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Source: PubMed

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