What is intestinal angina?

DEAR DOCTOR K:

For months I’ve experienced severe pain in my abdomen after eating. After excluding a number of other conditions, my doctor diagnosed intestinal angina. I’ve heard of angina related to the heart — is this the same?

DEAR READER:

The underlying process is the same for intestinal and cardiac angina. Let me explain.

Cholesterol-filled plaque and clots can lurk in blood vessels throughout the body. The arteries that supply the heart are by far the most common hiding place. But arteries elsewhere in the body can also become severely narrowed by plaque.

Clogged vessels in the legs or arms can lead to limb pain during exercise, because the nearby muscles don’t get enough blood to work properly. This is called peripheral artery disease, or PAD. People with PAD are also at risk for narrowing in the arteries that feed the intestines.

Your digestive system ordinarily gets about 20 to 25 percent of the blood pumped out by your heart. After you eat, blood flow to the stomach and intestines almost doubles. But if plaque causes severe narrowing, not enough of that extra blood reaches the intestines when they’re working to digest food. People usually don’t develop symptoms unless at least two of the three major arteries to the bowel are involved.

These narrowed vessels cause intestinal angina. The classic symptom is pain in the abdomen, just above the navel, that occurs about 30 minutes after eating. This pain happens every time you eat, not just some of the time. People often describe the pain as an aching sensation that lasts from one to two hours. Other possible symptoms include diarrhea, nausea and vomiting. Intestinal angina symptoms are so unpleasant that people with this condition are often afraid to eat.

Treating intestinal angina means restoring blood flow to the intestines. In most cases, doctors thread a catheter (a thin plastic tube) through several arteries until the tip of the catheter is at the site of the blockage. Then they insert a tiny metal mesh tube (stent) to prop open the artery. (This is very similar to the procedure performed to treat narrowed coronary arteries.) But just like stented coronary arteries, intestinal arteries are prone to re-narrowing. Some people with more advanced disease need surgery.

In rare cases, a blood clot may completely block an intestinal artery. This causes intense abdominal pain that can last for several hours. A complete blockage requires emergency surgery. Otherwise, the part of the intestine that is downstream from the blockage begins to die. If it is not promptly corrected, the condition is often fatal. The parallels to angina of the heart and a full heart attack are clear.

A doctor colleague of mine began to experience abdominal pain following every meal. At first he thought it was heartburn. But he began to wonder if it was intestinal angina. Then one night he was awakened by more severe pain in the same part of his abdomen. He hadn’t eaten in seven hours. Fortunately, he realized what was happening, went to the emergency room and then promptly to surgery. They removed a part of his intestine that had died and saved his life.