Diagnosis of Chronic Gastrointestinal Ischemia

Three aortic branches provide the arterial blood supply to the gastrointestinal tract: the celiac artery (CA), superior mesenteric artery (SMA) and inferior mesenteric artery (IMA). The CA supplies stomach, liver, part of the pancreas and proximal part of the duodenum. The SMA supplies the distal part of the duodenum, the entire small bowel and the proximal colon. The IMA is relatively small and supplies the distal colon. The anatomy of these arteries varies largely and gastrointestinal artery stenotic disease is not uncommon. Occlusive gastrointestinal arterial disease often remains asymptomatic, due to the presence of abundant collateral circulation. Only patients with significant arterial stenosis in combination with insufficient collateral circulation develop clinical signs of mesenteric ischemia. In these cases, the diagnosis is often missed due to lack of sensitive diagnostic tests. The diagnostic approach in patients with possible chronic gastrointestinal ischemia (CGI) focuses on identification of gastrointestinal arterial stenosis and demonstration of mucosal ischemia. This thesis deals with the diagnosis of chronic gastrointestinal ischemia, which often remains a clinical challenge. This in part explains why CGI was for long considered to be a very rare disease, only presenting in patients with multiple stenotic abdominal arterial disease. The existence of single vessel abdominal arterial disease has long been debated. We therefore firstly reviewed the existence and characteristics of single vessel abdominal arterial disease

Parenting children with a cleft lip with or without palate or a visible infantile hemangioma: A cross-sectional study of distress and parenting stress

Objective: Parents of children with a medical condition and a visible difference can experience challenging situations. We evaluated distress and parenting stress in parents of children with a cleft lip with or without cleft palate (CL +/- P) or a visible infantile hemangioma (IH). Setting: This cross-sectional study took place in an academic medical hospital in Rotterdam, the Netherlands. Participants: Three-hundred nine parents (mean age = 40.30, 56.00% mothers) of children with CL +/- P and 91 parents (mean age = 36.40, 58.24% mothers) of children with IH. Main Outcome Measures: The Dutch version of the Parenting Stress Index - Short Form and the subscales Anxiety, Depression, and Hostility of the Symptom Checklist - 90. Results: One sample t tests and mixed linear modeling were used. On average, parents of children with CL +/- P and of children with IH showed significantly lower parenting stress compared to normative data. Anxiety was significantly lower in parents of children with CL +/- P than that in the norm group. Visibility of the condition was not related to distress or parenting stress. Child behavioral problems were positively related to parenting stress, depression, and hostility. Conclusions: Parents of children with CL +/- P and IH report less distress and parenting stress compared to the norm. On average, these parents seem well adjusted. A practical implication is to monitor parents of children with behavioral problems.Stress and Psychopatholog

Patients with chronic gastrointestinal ischemia have a higher cardiovascular disease risk and mortality

Objectives: We determined the prevalence of classical risk factors for atherosclerosis and mortality risk in patients with CGI. Methods: A case-control study was conducted. Patients referred with suspected CGI underwent a standard work-up including risk factors for atherosclerosis, radiological imaging of abdominal vessels and tonometry. Cases were patients with confirmed atherosclerotic CGI. Controls were healthy subjects previously not known with CGI. The mortality risk was calculated as standardized mortality ratio derived from observed mortality, and was estimated with ten-year risk of death using SCORE and PREDICT. Results: Between 2006 and 2009, 195 patients were evaluated for suspected CGI. After a median follow-up of 19 months, atherosclerotic CGI was diagnosed in 68 patients. Controls consisted of 132 subjects. Female gender, diabetes, hypercholesterolemia, a personal and family history of cardiovascular disease (CVD), and current smoking are highly associated with CGI. After adjustment, female gender (OR 2.14 95% CI 1.05-4.36), diabetes (OR 5.59, 95% CI 1.95-16.01), current smoking (OR 5.78, 95% CI 2.27-14.72), and history of CVD (OR 21.61, 95% CI 8.40-55.55) remained significant. CGI patients >55 years had a higher median ten-year risk of death (15% vs. 5%, P = 0.001) compared to controls. During follow-up of 116 person-years, standardized mortality rate was higher in CGI patients (3.55; 95% CI 1.70-6.52). Conclusions: Patients with atherosclerotic CGI have an increased estimated CVD risk, and severe excess mortality. S