Related Experiment Video
Updated: Feb 2, 2026
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Patients with chronic mesenteric ischemia have an altered sublingual microcirculation
Jihan Harki1, Mustafa Suker2, M Sherezade Tovar-Doncel3
1Department of Gastroenterology and Hepatology, j.harki@erasmusmc.nl.
Background:
Little is known about the microcirculatory alterations in patients with chronic mesenteric ischemia (CMI). We hypothesized that patients with CMI have an impaired microcirculatory function and show an oral microcirculatory response after caloric challenge compared to healthy controls.
Methods:
All patients and controls received the standard workup for CMI. Sublingual micro-circulation was evaluated before (T0) and 20 minutes after (T1) feeding. The total vessel density (TVD; mm/mm2), perfused vessel density (PVD; mm/mm2), proportion of perfused vessels (PPV; %) and microvascular flow index (MFI; AU) were assessed.
Results:
We included 12 patients (63.2 years [IQR 48.8-70.4 years], 67% males) and 12 controls (32.7 years [IQR 27.7-38.1 years], 42% males). At baseline, patients with CMI had a decreased PPV of the sublingual small vessels (median 84.8% vs 95.7%, P=0.006), PPV of all vessels (PPV median 85.4% vs 95.3%, P=0.007) and microvascular flow index of all vessels (MFIa; median 3.00 vs 2.80, P=0.039) compared to healthy controls. After caloric challenge, PVD increased significantly in both small vessels (perfused vessel density of the small vessels [PVDs]) and all vessels (perfused vessel density of all vessels [PVDa]; PVDs [T0]) median 16.3 [IQR 13.3-22.1] vs [T1] median 19.9 [IQR 14.2-26.2], P=0.008; PVDa [T0] median 19.1 [IQR 16.2-23.6] vs [T1] median 22.2 [IQR 16.5-28.9], P=0.02; proportion of perfused vessels of the small vessels (PPVs; [T0] median 84.8% [IQR 75.3-90.4] vs [T1] median 91.0% [IQR 80.1-93.8], P=0.010). In contrast, no significant changes in microcirculatory parameters were observed after caloric challenge in healthy controls.
Conclusion:
Patients with CMI have an impaired sublingual microcirculation at baseline and show a significant response in the sublingual microcirculation after caloric challenge, whereas healthy controls have a normal microcirculation at baseline and show no reactive response upon a caloric challenge as seen in CMI patients. Sublingual microcirculation visualization may offer a rapid noninvasive method to identify patients at risk for having CMI.
Insights
Patients with chronic mesenteric ischemia (CMI) exhibit impaired sublingual microcirculation. A caloric challenge reveals a reactive microcirculatory response in CMI patients, unlike healthy controls, suggesting a potential diagnostic marker.
Area of Science:
- Cardiovascular Medicine
- Gastroenterology
- Medical Diagnostics
Background:
- Microcirculatory alterations in chronic mesenteric ischemia (CMI) are poorly understood.
- Hypothesis: CMI patients have impaired microcirculatory function and a distinct oral microcirculatory response to caloric challenge compared to controls.
Purpose of the Study:
- To investigate sublingual microcirculatory function in patients with CMI.
- To assess the microcirculatory response to a caloric challenge in CMI patients versus healthy controls.
Main Methods:
- Sublingual micro-circulation assessment (total vessel density, perfused vessel density, proportion of perfused vessels, microvascular flow index) before and after a caloric challenge.
- Comparison between 12 CMI patients and 12 healthy controls.
Main Results:
- CMI patients showed decreased proportion of perfused vessels and microvascular flow index at baseline compared to controls.
- Following caloric challenge, CMI patients demonstrated significant increases in perfused vessel density and proportion of perfused vessels.
- Healthy controls exhibited no significant microcirculatory changes after caloric challenge.
Conclusions:
- CMI patients present with impaired baseline sublingual microcirculation and a reactive response to caloric challenge.
- Healthy individuals have normal baseline microcirculation without a reactive response to caloric challenge.
- Sublingual microcirculation visualization may serve as a rapid, noninvasive tool for identifying patients at risk for CMI.
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