What Is Ischemic Bowel Disease?

With ischemic bowel disease, which usually affects people over the age of 50, the arteries that supply oxygenated blood to the large and small intestines become narrowed or blocked. The result is that the bowels don't receive enough oxygen. Ischemic bowel disease may be painful, particularly after meals, and ultimately damage the intestine. Mild ischemic bowel disease may be difficult to diagnose but catching it early means that a potentially serious situation may be avoided, namely severe damage due to lack of oxygen.

Causes

• Any blockage or narrowing of the arteries feeding blood to the bowels can result in ischemic bowel disease. Possible blockages include tumors and blood clots, while the narrowing happens through a process called atherosclerosis. Atherosclerosis begins when the artery's inner wall becomes damaged. Possible culprits include smoking, infection, diabetes and high blood pressure. The arterial wall will try to repair itself, but in the process cholesterol builds up on the artery's inside surface. As this "plaque" becomes thicker, the artery becomes narrower and blood flow is reduced. It is at this point that ischemic bowel syndrome enters the picture.

Incidence and Stages

• Dr. Robert A. Novelline, a professor of radiology at Harvard Medical School, reports that ischemic bowel disease accounts for approximately 1 of every 1,000 hospital admissions. Additionally, he lists the three stages of acute bowel ischemia and how treatable each is. First is ischemic enteritis/colitis. This stage includes mucosal necrosis, which means that most or all of the cells in the intestinal mucosa (the layer of mucus that lubricates and protects the interior wall of the intestine) have died due to insufficient blood flow. This step is reversible. The second stage, which sometimes heals with treatment, includes necrosis of the sub mucosal and muscular layers of the intestine. Finally, comes transmural bowel wall necrosis, which means that the bowel wall has been compromised when an area of tissue dies due to sudden lack of blood. If this point is reached, immediate surgery is necessary.

Risk Factors

• Because the third stage of acute ischemic bowel disease is impossible to fix and early stages are often difficult to diagnose, it is important to note whether you are at risk for this disorder. If you are over 50 years old, you are automatically at risk for the disease. Smoking increases that risk. Obesity and the health problems associated with it, like high cholesterol and high blood pressure, further increase the likelihood of ischemic bowel disease. Other health problems including sustained abnormal heart beat, stroke, deep vein thrombosis and heart attack further drive up your chances. Finally, shock induced by heavy blood loss could result in ischemic bowel disease. If you are over 50 and have dealt with any of these issues, it is important to pay particular attention to any symptoms of ischemic bowel disease you experience.

Symptoms

• Early on, you may think you just have a stomachache. Pay attention to the type of pain you feel. The abdominal pain associated with ischemic bowel disease is an inconsistent cramping pain that gets worse after you eat. Constipation and diarrhea are both symptoms of ischemic bowel disease, as is black or red stool caused by the presence of blood. If you note any rectal bleeding, you should consult your doctor to be tested for ischemic bowel disease. As the disease worsens, the symptoms become more obvious. Both the frequency and intensity of abdominal pain worsens. Similarly, the amount of blood in the stool generally increases. Additional symptoms may crop up, including repeated vomiting, which may or may not include blood, and a fever. If these more serious symptoms appear, see your doctor immediately.

Diagnosis

• Your doctor's evaluation will typically include an evaluation of your medical history, a physical examination, and the testing of your stool for blood. If you are diagnosed with mild ischemic bowel disease, your doctor will most likely simply monitor your progress carefully, as this disorder may sometimes resolve itself without treatment. Taking steps to manage the development of atherosclerosis such as quitting smoking, exercising, avoiding alcohol and adopting a healthy diet (particularly if you're overweight) may curb the progress of ischemic bowel disease. If your diagnosis comes at a later stage, appropriate treatments, which may include surgery, will be considered.