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Updated: Jul 14, 2026
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
What is the best diagnostic approach for chronic gastrointestinal ischemia?
Johannes A Otte1, Robert H Geelkerken, Ad B Huisman
1Departments of Internal Medicine and Gastroenterology, Medisch Spectrum Twente, Enschede, The Netherlands.
Insights
Diagnosing chronic gastrointestinal ischemia is challenging. Combining gastric tonometry exercise (GET) and duplex sonography offers the best screening accuracy, avoiding missed diagnoses and reducing unnecessary angiographies.
Area of Science:
- Vascular Medicine
- Diagnostic Imaging
- Gastroenterology
Background:
- Chronic gastrointestinal ischemia diagnosis is challenging, often relying on clinical suspicion and selective angiography.
- Duplex sonography and gastric tonometry exercise (GET) show promise as screening tools for splanchnic artery stenosis and ischemia.
- Comparing diagnostic approaches is crucial for optimizing patient care.
Purpose of the Study:
- To compare the diagnostic accuracy of four different approaches for suspected chronic gastrointestinal ischemia.
- To evaluate the effectiveness of duplex sonography and GET as initial screening methods.
- To determine the optimal diagnostic workup strategy.
Main Methods:
- 84 patients with suspected chronic gastrointestinal ischemia were evaluated between 1997-2000.
- All patients underwent splanchnic arterial angiography, duplex sonography, and GET.
- Four diagnostic strategies were compared, using angiography as the gold standard for stenosis and panel decision for ischemia diagnosis.
Main Results:
- Chronic gastrointestinal ischemia was diagnosed in 28 patients.
- Clinical suspicion alone missed 57% of cases.
- Combined GET and duplex sonography screening identified all symptomatic ischemia cases and could reduce angiographies by 21%.
Conclusions:
- Combined screening with gastric tonometry exercise and duplex sonography demonstrates excellent diagnostic accuracy for chronic gastrointestinal ischemia.
- This combined approach is currently the most effective diagnostic strategy for patients with suspected chronic gastrointestinal ischemia.
- Integrating non-invasive screening methods improves diagnostic yield and efficiency.
Background:
Chronic gastrointestinal ischemia is still a difficult diagnosis to establish. The diagnosis depends on a high degree of clinical suspicion as well as selective angiography. Duplex sonography may serve as a screening tool, providing information on splanchnic vessel patency and flow patterns. GET is a minimally invasive test that can be used for diagnosis in patients with chronic gastrointestinal ischemia, and can differentiate between symptomatic and asymptomatic splanchnic artery stenosis. In the present study, we compared four different diagnostic approaches.
Methods:
Between 1997 and 2000, 84 patients were evaluated for suspected chronic gastrointestinal ischemia. All underwent splanchnic arterial angiography, duplex sonography, and GET. For the presence or absence of stenosis, angiography was used as the gold standard. For diagnosing ischemia, we relied on a panel decision. The diagnostic approaches studied were: (a) angiography, only in patients with classic abdominal angina; (b) screening with duplex sonography, angiography if sonography abnormal or unreliable; (c) screening with gastric tonometry and angiography if tonometry not normal; (d) both gastric tonometry exercise and duplex sonography, angiography if one of both screening tests not normal.
Results:
In 28 patients, chronic gastrointestinal ischemia was diagnosed. Using clinical suspicion only, 16 patients (57%) would have been missed. Screening by duplex sonography or gastric tonometry only would have missed 4 or 6 patients, respectively. Screening with combined gastric tonometry and duplex sonography would not have missed patients with symptomatic ischemia, while 21% of angiographies would have been avoided.
Conclusion:
Screening by combined GET and duplex sonography has excellent diagnostic accuracy. Currently, this approach represents the best diagnostic workup strategy in patients with suspected chronic gastrointestinal ischemia.
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