title: What is the best diagnostic approach for chronic gastrointestinal ischemia?
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Departments of Internal Medicine and Gastroenterology, Medisch Spectrum Twente, Enschede, The Netherlands.
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Otte
authors.forename: Robert H
authors.initials: RH
authors.lastname: Geelkerken
authors.forename: Ad B
authors.initials: AB
authors.lastname: Huisman
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Kolkman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D001783:Blood Flow Velocity; D015444:Exercise; D005260:Female; D041981:Gastrointestinal Tract / Q000098:blood supply*; D006801:Humans; D007511:Ischemia / Q000175:diagnosis*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D013152:Splanchnic Circulation; D018616:Ultrasonography, Doppler, Duplex