title: Combining radiological imaging and gastrointestinal tonometry: a minimal invasive and useful approach for the workup of chronic gastrointestinal ischemia.
abstract: BACKGROUND
  The established approach for patients suspected of chronic gastrointestinal ischemia (CGI) includes assessment of medical history, vascular imaging, such as by digital subtraction angiography, and, more recently, computed tomography angiography (CTA) or magnetic resonance angiography. Mucosal perfusion assessment techniques have recently been shown to be of additional diagnostic value, including visible light spectroscopy and gastric exercise tonometry. Gastric exercise tonometry, however, is cumbersome and impossible to perform in a considerable proportion of patients. An alternative approach is provided by 24 h gastrointestinal tonometry (TM). We challenged the use of TM in combination with CTA as an alternative approach to evaluate patients suspected of CGI.
  
  
  METHODS
  Patients referred for suspected CGI were prospectively evaluated using CTA and TM, and discussed in a multidisciplinary team, where a consensus diagnosis was made. CGI patients were offered therapy. Persistent symptom relief after adequate therapy during follow-up was used as the 'gold standard' and was defined as a definitive diagnosis of CGI.
  
  
  RESULTS
  In 31 months, 186 patients were included (men 69, mean age 63 years). A consensus diagnosis of CGI was made in 128 (69%) patients: 94 with occlusive and 34 with nonocclusive CGI. After a median follow-up of 21 months after a therapeutical intervention, 91% of the CGI patients were free from symptoms.
  
  
  CONCLUSIONS
  In patients clinically suspected of CGI, the combination of CTA and TM provides a minimally invasive, reliable diagnostic approach, which seems to be very useful in clinical practice and to have an outcome similar to the established diagnostic workup.
authors: Departments of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, ’s-Gravendijkwal 230, Rotterdam, The Netherlands. d.vannoord@erasmusmc.nl
authors: Désirée
authors: D
authors: van Noord
authors: Aria
authors: A
authors: Sana
authors: Leon M
authors: LM
authors: Moons
authors: Peter M
authors: PM
authors: Pattynama
authors: Hence J
authors: HJ
authors: Verhagen
authors: Ernst J
authors: EJ
authors: Kuipers
authors: Peter B
authors: PB
authors: Mensink
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D041981:Gastrointestinal Tract / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007511:Ischemia / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult