Article Text
Abstract
Background Diagnosis of gastric ischaemia is difficult and angiography is an invasive procedure. Angiographic findings may not correlate with clinical importance.
Aims To investigate whether tonometric measurement of intragastric Pco 2during exercise can be used to detect clinically important gastric ischaemia.
Methods Fourteen patients with unexplained abdominal pain or weight loss were studied. Splanchnic angiography served as the gold standard. Three patients were studied again after a revascularisation procedure. Gastric Pco 2 was measured from a nasogastric tonometer, with 10 minute dwell times, and after acid suppression. Gastric and capillary Pco 2 were measured before, during, and after submaximal exercise of 10 minutes duration.
Results Seven patients had normal angiograms; seven had more than 50% stenosis in the coeliac (n=7) or superior mesenteric artery (n=4). Normal subjects showed no changes in tonometry. In patients with stenoses, the median intragastric Pco 2(Pico 2) at rest was 5.2 kPa (range 4.8–11.2) and rose to 6.4 kPa (range 5.7–15.7) at peak exercise; the median intragastric blood Pco 2 gradient increased from 0.0 kPa (range −0.8 to 5.9) to 1.7 kPa (range 0.9 to 10.3; p<0.01). Only two subjects had abnormal tonometry at rest; all had supernormal values at peak exercise. The Pco 2 gradient correlated with clinical and gastroscopic severity; in patients reexamined after revascularisation (n=3), exercise tonometry returned to normal.
Conclusion Gastric tonometry during exercise is a promising non-invasive tool for diagnosing and grading gastrointestinal ischaemia and evaluating the results of revascularisation surgery for symptomatic gastric ischaemia.
- gastric ischaemia
- tonometry
- carbon dioxide
- exercise test
Abbreviations
- CA
- coeliac artery
- IMA
- inferior mesenteric artery
- Pco2
- partial pressure of carbon dioxide
- Pico2
- intragastric Pco2
- SMA
- superior mesenteric artery
- cBic
- capillary bicarbonate content
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Abbreviations
- CA
- coeliac artery
- IMA
- inferior mesenteric artery
- Pco2
- partial pressure of carbon dioxide
- Pico2
- intragastric Pco2
- SMA
- superior mesenteric artery
- cBic
- capillary bicarbonate content