Gastric exercise tonometry: the key investigation in patients with suspected celiac artery compression syndrome.
BACKGROUND
Controversy continues about the mere existence of the celiac artery compression syndrome. Earlier results of treatment of unselected patients groups showed varying, mostly disappointing, results. The recently introduced gastric exercise tonometry test is able to identify patients with actual gastrointestinal ischemia. We prospectively studied the use of gastric exercise tonometry as a key criterion for revascularization treatment in patients with otherwise unexplained abdominal complaints and significant stenosis of the celiac artery by compression of the arcuate ligament.


METHODS
Patients were prospectively selected using abdominal artery angiography and gastric exercise tonometry. Patients with a significant compression of the celiac artery, typical abdominal complaints, and abnormal tonometry were considered for revascularization.


RESULTS
Over a 7-year period, 43 patients with significant celiac artery compression were included in this study, and 30 patients were diagnosed as ischemic. Twenty-nine patients had revascularization, 22 (76 %) had a trunk release only. After a median follow-up of 39 months, 83% of patients were free of symptoms. The repeated tonometry after treatment improved in 100% of patients free of symptoms, compared with 25% in patients with persistent complaints after revascularization.


CONCLUSIONS
The results of this study suggest that the celiac axis compression syndrome exists and that the actual ischemia can be detected by gastric exercise tonometry and treated safely, with success.
Mensink
Peter B F
PB
Department of Internal Medicine and Gastroenterology, Medisch Spectrum Twente, Enschede, the Netherlands.
van Petersen
Andre S
AS
Kolkman
Jeroen J
JJ
Otte
Johannes A
JA
Huisman
Ad B
AB
Geelkerken
Robert H
RH
D000293:Adolescent; D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D002445:Celiac Artery / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D003251:Constriction, Pathologic; D003663:Decision Trees; D005080:Exercise Test; D005260:Female; D041981:Gastrointestinal Tract / Q000098:blood supply* / Q000000981:diagnostic imaging; D006801:Humans; D007511:Ischemia / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013152:Splanchnic Circulation; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures